How to do a Roof Line and Prove Block
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How to do a Roof Line and Prove Block
Dhiraj GuptaLiverpool Heart and Chest Hospital
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Schema
• Why?
• Where?
• How?
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Why?
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Where?Transverse line between septal & lateral
veins
Roof is the shortest distance
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LA-Esophagus relationship
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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
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Roof Line in Sinus Rhythm
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How to prove block?
Sinus Rhythm: Sang et al, JCE 2010; 21: 741-6
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Roof Line in AF
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Our experience
Oral presentation at Cardiostim, Nice June 2010
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‘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
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True PAF Sustained PAF
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Persistent AF Long-standing PsAF
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• 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
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Conclusions
• LA roof line often the first step in substrate modification
• ‘Easiest’ linear lesion to create
• Caudocranial activation of the posterior wall confirms block