How to do a Roof Line and Prove Block

Dhiraj GuptaLiverpool Heart and Chest Hospital

Schema

• Why?

• Where?

• How?

Why?

Where?Transverse line between septal & lateral

veins

Roof is the shortest distance

LA-Esophagus relationship

How?

• Need anchors on either side

• Both upper PVs need to be isolated first!

• Aims

• Immediate: get contiguous transmural lesions

• Final: Conduction detour

• In Sinus/ AF

Roof Line in Sinus Rhythm

How to prove block?

Sinus Rhythm: Sang et al, JCE 2010; 21: 741-6

Roof Line in AF

Our experience

Oral presentation at Cardiostim, Nice June 2010

‘Sustained PAF’

• Patients with PAF, with ≥2 of

• Any individual AF episodes>24 hours

• Mod/ Severe LA enlargement (>4.5 cm)

• Age >65 years

• Long History of AF (> 5 years)

• Documented flutter

• True PAF

True PAF Sustained PAF

Persistent AF Long-standing PsAF

• 194 patients

• 138 Roof Lines

• Average Procedure time: 10-15 minutes

• No acute complication

• 2 roof dependent flutters on follow-up

Sep 2008-Sep 2010

Conclusions

• LA roof line often the first step in substrate modification

• ‘Easiest’ linear lesion to create

• Caudocranial activation of the posterior wall confirms block