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.