4.3 | The feasibility of LAPW isolation
Our study demonstrated the excellent efficacy of PFA in isolating the LAPW within a short procedure time without esophageal injury. However, further investigation is warranted to assess the transmurality of PFA lesions in the LA dome. Ablating atrial tachycardias within the LAPW, particularly the epicardial roof-dependent macro-reentrant tachycardias associated with the septopulmonary bundle, is a challenge.13 Progressive RFCA to achieve transmural lesions can cause the risk of esophageal injury. The mechanical esophagus deviation is promising to protect the esophagus from thermal injury. However esophagus deviation itself brings about mechanical injury to the esophagus mucosa. LAPW isolation with PFA may be a good strategy for the tissue selectiveness of PFA that selectively spares the esophagus. One recent case has reported that in some patients, LAPW epicardial conduction cannot be blocked via repeated PFA, which was eventually ablated by ethanol infusion into the vein of Marshall.14 Therefore, evaluating the transmuralilty of PFA lesions in the posterior wall still requires further studies.