{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T08:29:11Z","timestamp":1789201751628,"version":"build-2803163510"},"reference-count":31,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,2,4]],"date-time":"2022-02-04T00:00:00Z","timestamp":1643932800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>(1) Background: The modified anterior line (MAL) has been described as an alternative to the mitral isthmus line. Despite better ablation results, achieving a bidirectional line block can be challenging. We aimed to investigate the ablation parameters that determine a persistent scar on late-gadolinium enhancement magnet resonance imaging (LGE-MRI) as a surrogate parameter for successful ablation 3 months after MAL ablation. (2) Methods: Twenty-four consecutive patients who underwent a MAL ablation have been included. The indication for MAL was perimitral flutter (n = 5) or substrate ablation in the diffuse anterior left atrial (LA) low-voltage area in persistent atrial fibrillation (AF) (n = 19). The MAL was divided into three segments: segment 1 (S1) from mitral annulus to height of lower region of left atrial appendage (LAA) antrum; segment 2 (S2) height of lower region of LAA antrum to end of upper LAA antrum; segment 3 (S3) from end of upper LAA antrum to left superior pulmonary vein. Ablation was performed using a contact force irrigated catheter with a power of 40 Watt and guided by automated lesion tagging and the Ablation Index (AI). The AI target was left to the operator\u2019s choice. An inter-lesion distance of \u22646 mm was recommended. The bidirectional block was systematically evaluated using stimulation maneuvers at the end of procedure. All patients underwent LGE-MRI imaging at 3 months, regardless of symptoms, to identify myocardial lesions (scars). (3) Results: Bidirectional MAL block was achieved in all patients. LGE-MRI imaging revealed scarring in 45 of 72 (63%) segments. In all three segments of MAL, ablation time and AI were significantly higher in scarred areas compared with non-scar areas. The mean AI value to detect a durable scar was 514.2 in S1, 486.7 in S2 and 485.9 in S3. The mean ablation time to detect a scar was 20.4 s in S1, 22.1 s in S2 and 20.2 s in S3. Mean contact force and impedance drop were not significantly different between scar and non-scar areas. (4) Conclusions: Targeting optimal AI values is crucial to determine persistent left atrial scars on an LGE-MRI scan 3 months after ablation. AI guided linear left atrial ablation seems to be effective in producing durable lesions.<\/jats:p>","DOI":"10.3390\/jcm11030830","type":"journal-article","created":{"date-parts":[[2022,2,6]],"date-time":"2022-02-06T20:38:40Z","timestamp":1644179920000},"page":"830","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Optimal Ablation Settings Predicting Durable Scar Detected Using LGE-MRI after Modified Left Atrial Anterior Line Ablation"],"prefix":"10.3390","volume":"11","author":[{"given":"Mathias","family":"Forkmann","sequence":"first","affiliation":[{"name":"Klinikum Coburg, Department of Cardiology and Angiology, 96450 Coburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Mahnkopf","sequence":"additional","affiliation":[{"name":"Klinikum Coburg, Department of Cardiology and Angiology, 96450 Coburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel","family":"Mitlacher","sequence":"additional","affiliation":[{"name":"Klinikum Coburg, Department of Cardiology and Angiology, 96450 Coburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Wolff","sequence":"additional","affiliation":[{"name":"Johnson & Johnson Medical GmbH, Biosense Webster, Robert-Koch-Str.1, 22851 Norderstedt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz","family":"Tose Costa Paiva","sequence":"additional","affiliation":[{"name":"Klinikum Coburg, Department of Cardiology and Angiology, 96450 Coburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Busch","sequence":"additional","affiliation":[{"name":"Klinikum Coburg, Department of Cardiology and Angiology, 96450 Coburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.hrthm.2009.09.067","article-title":"Peri-mitral atrial flutter in patients with atrial fibrillation ablation","volume":"7","author":"Matsuo","year":"2010","journal-title":"Heart Rhythm"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1093\/europace\/euu297","article-title":"Ablation of perimitral flutter: Acute and long-term success of the modified anterior line","volume":"17","author":"Ammar","year":"2015","journal-title":"Europace"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1766","DOI":"10.1093\/europace\/eux310","article-title":"Individually tailored vs. standardized substrate modification during radiofrequency catheter ablation for atrial fibrillation: A randomized study","volume":"20","author":"Kircher","year":"2018","journal-title":"Europace"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1111\/j.1540-8167.2009.01681.x","article-title":"The modified anterior line: An alternative linear lesion in perimitral flutter","volume":"21","author":"Tzeis","year":"2010","journal-title":"J. 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PACE"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/3\/830\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:14:13Z","timestamp":1760134453000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/3\/830"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,4]]},"references-count":31,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["jcm11030830"],"URL":"https:\/\/doi.org\/10.3390\/jcm11030830","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,4]]}}}