Ethanol infusion in left atrial appendage vein for treating refractory left atrial appendage tachycardia

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Refractory left atrial appendage tachycardia (n=1). Intervention: Ethanol infusion in left atrial appendage vein vs. Radiofrequency ablation (prior failure). Primary outcome: Termination of tachycardia and recurrence.

Q: What does this research mean for the field?

Chemical ablation via ethanol infusion in the left atrial appendage vein can successfully terminate atrial tachycardias emanating from the left atrial appendage that are resistant to radiofrequency ablation. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Fabien Squara; Didier Scarlatti; Delphine Baudouy; Sok‐Sithikun Bun; Pamela Moceri; Émile Ferrari

doi:10.1111/jce.15966

June 9, 2023Journal of Cardiovascular ElectrophysiologyOpen Access

Ethanol infusion in left atrial appendage vein for treating refractory left atrial appendage tachycardia

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Key result

Ethanol infusion in the LAA vein immediately terminates refractory AT with no 12-month recurrence.

n=1

Why the study?

Does ethanol infusion in the left atrial appendage vein terminate refractory left atrial appendage tachycardia?

Study Design

Type

Case Report (n=1)

Structured PICO

Does ethanol infusion in the left atrial appendage vein terminate refractory left atrial appendage tachycardia?

P

Population

1 66-year-old patient with cardiac amyloidosis and history of persistent atrial fibrillation ablation presenting with poorly tolerated atrial tachycardia (AT) with 1:1 atrioventricular nodal conduction at 135/min despite amiodarone therapy.

I

Intervention

Selective catheterization and ethanol infusion in the left atrial appendage (LAA) vein (chemical ablation).

O

Outcome

Termination of tachycardia.

Chemical ablation with ethanol infusion in the LAA vein may be an effective alternative for atrial tachycardias emanating from the LAA that are resistant to radiofrequency ablation.

Implication

May support ethanol infusion as bailout for refractory LAA tachycardia; leaves open efficacy and safety in prospective studies.

Abstract

INTRODUCTION: We describe an unusual case of atrial tachycardia (AT) emanating from the left atrial appendage body (LAA), successfully treated by chemical ablation. METHODS: A 66-year-old patient with cardiac amyloidosis and history of persistent atrial fibrillation ablation presented poorly tolerated AT with 1:1 atrioventricular nodal conduction at 135/min, despite amiodarone therapy. Three-dimensional mapping suggested a reentrant AT from the anterior aspect of the left LAA. RESULTS: The tachycardia could not be terminated with radiofrequency ablation. The LAA vein was then selectively catheterized and infused with Ethanol, resulting in immediate termination of tachycardia, without LAA isolation. No recurrence occurred at 12 months. CONCLUSION: Atrial tachycardias emanating from the LAA that are resistant to radiofrequency ablation may respond to chemical ablation of the LAA vein.

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Cite This Study

Squara et al. (2023) conducted a case report in Refractory left atrial appendage tachycardia (n=1). Ethanol infusion in left atrial appendage vein vs. Radiofrequency ablation (prior failure) was evaluated on Termination of tachycardia and recurrence. Ethanol infusion in the left atrial appendage vein resulted in immediate termination of refractory atrial tachycardia with no recurrence at 12 months.

synapsesocial.com/papers/6a0a58e4fdd00ab7863dcd95 https://doi.org/10.1111/jce.15966