Why the study?
Achieving bidirectional MI block with RFCA alone is challenging and reconnection is common; although adjunctive VOM-Et facilitates acute block, its long-term success was unclear.
Does adjunctive vein of Marshall ethanol infusion improve acute mitral isthmus block and reduce reconnection compared to RFCA alone in patients undergoing posterior MI ablation?
Does adjunctive vein of Marshall ethanol infusion improve acute mitral isthmus block and reduce reconnection compared to RFCA alone in patients undergoing posterior MI ablation?
Adjunctive vein of Marshall ethanol infusion improves the acute success and long-term durability of mitral isthmus block compared to radiofrequency ablation alone.
May support durable mitral isthmus ablation; leaves open confirmation in randomized trials.
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. 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.
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Nakashima et al. (2020) studied this question.
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