BACKGROUND: Achieving bidirectional mitral isthmus (MI) block using radiofrequency catheter ablation (RFCA) alone is challenging, and MI reconnection is common. Adjunctive vein of Marshall (VOM) ethanol infusion (VOM-Et) can facilitate acute MI block. However, little is known about its long-term success. This study sought to evaluate the impact of adjunctive VOM-Et on MI block achievement and durability compared with RFCA alone. METHODS: Patients undergoing the first attempt of posterior MI ablation were grouped according to their MI block index strategy: adjunctive VOM-Et and RFCA alone. Rates of acute MI block and MI reconnection observed during repeat procedures were compared between the 2 groups. RESULTS: The VOM-Et group consisted of 152 patients (63.8±9.4 years) undergoing adjunctive VOM-Et for MI block. The RFCA group consisted of 110 patients (60.9±9.2 years) undergoing MI ablation using RFCA alone. Acute MI block was more frequently achieved in the VOM-Et group (98.7% [150/152] versus 63.6% [70/110]; P<0.001) with shorter RFCA duration (5.00 [3.00-7.00] versus 19.0 [13.6-22.0] minutes; P<0.001). Of the 220 patients with MI block achieved during the index procedure, 81 underwent a repeat procedure during follow-up (VOM-Et group: 23.3% [35/150] versus RFCA group: 65.7% [46/70], respectively; P<0.001). A significantly greater number of patients exhibited durable MI block in the VOM-Et group (62.9% [22/35] versus 32.6% [15/46], respectively; P=0.008). CONCLUSIONS: Beyond facilitating acute MI block, VOM-Et is associated with greater lesion durability as evidenced by higher rates of MI block during repeat procedures.
BACKGROUND: Achieving bidirectional mitral isthmus (MI) block using radiofrequency catheter ablation (RFCA) alone is challenging, and MI reconnection is common. Adjunctive vein of Marshall (VOM) ethanol infusion (VOM-Et) can facilitate acute MI block. However, little is known about its long-term success. This study sought to evaluate the impact of adjunctive VOM-Et on MI block achievement and durability compared with RFCA alone. METHODS:Patients undergoing the first attempt of posterior MI ablation were grouped according to their MI block index strategy: adjunctive VOM-Et and RFCA alone. Rates of acute MI block and MI reconnection observed during repeat procedures were compared between the 2 groups. RESULTS: The VOM-Et group consisted of 152 patients (63.8±9.4 years) undergoing adjunctive VOM-Et for MI block. The RFCA group consisted of 110 patients (60.9±9.2 years) undergoing MI ablation using RFCA alone. Acute MI block was more frequently achieved in the VOM-Et group (98.7% [150/152] versus 63.6% [70/110]; P<0.001) with shorter RFCA duration (5.00 [3.00-7.00] versus 19.0 [13.6-22.0] minutes; P<0.001). Of the 220 patients with MI block achieved during the index procedure, 81 underwent a repeat procedure during follow-up (VOM-Et group: 23.3% [35/150] versus RFCA group: 65.7% [46/70], respectively; P<0.001). A significantly greater number of patients exhibited durable MI block in the VOM-Et group (62.9% [22/35] versus 32.6% [15/46], respectively; P=0.008). CONCLUSIONS: Beyond facilitating acute MI block, VOM-Et is associated with greater lesion durability as evidenced by higher rates of MI block during repeat procedures.
Authors: Mohammed Mhanna; Azizullah Beran; Ahmad Al-Abdouh; Omar Sajdeya; Mohammed Altujjar; Modar Alom; Abdelrhman M Abumoawad; Ahmed M Elzanaty; Paul Chacko; Ehab A Eltahawy Journal: J Atr Fibrillation Date: 2021-06-30
Authors: Adi Lador; Leif E Peterson; Vijay Swarup; Paul A Schurmann; Akash Makkar; Rahul N Doshi; David DeLurgio; Charles A Athill; Kenneth A Ellenbogen; Andrea Natale; Jayanthi Koneru; Amish S Dave; Irakli Giorgberidze; Hamid Afshar; Michelle L Guthrie; Raquel Bunge; Carlos A Morillo; Neal S Kleiman; Miguel Valderrábano Journal: Heart Rhythm Date: 2021-01-19 Impact factor: 6.779
Authors: Marc Kottmaier; Felix Bourier; Sonia Busch; Philipp Sommer; Tilman Maurer; Till Althoff; Dong-In Shin; David Duncker; Victoria Johnson; Heidi Estner; Andreas Rillig; Leon Iden; Roland Tilz; Andreas Metzner; K R Julian Chun; Daniel Steven; Henning Jansen; Amir Jadidi; Christian Ewertsen; Tilko Reents Journal: Herzschrittmacherther Elektrophysiol Date: 2022-08-19