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January 11, 2024Journal of Interventional Cardiac ElectrophysiologyOpen Access

A proposed index of myocardial staining for vein of Marshall ethanol infusion: an Italian single-center experience

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Why the study?

Fluorographic myocardial staining during VOM-EI could predict procedural alcoholization outcomes, but its role is routinely assessed qualitatively rather than quantitatively.

Does a higher myocardial staining index during vein of Marshall ethanol infusion predict mitral isthmus block achievement in patients with persistent atrial fibrillation?

Population

42 patients with persistent AF and identifiable VOM undergoing catheter ablation

Comparison

Quantitative assessment of myocardial staining via a proposed index

Design

Single-center retrospective study

Key result

A higher myocardial staining index during vein of Marshall ethanol infusion was significantly associated with the achievement of mitral isthmus block (OR 1.24).

Authors

FLFederico LandraMNMartina NestiSGS Garibaldi

Discussion

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Overview

MSI may aid mitral isthmus block prediction during VOM ethanol infusion; hypothesis-generating and requires prospective validation.

Key Points

  • To quantitatively evaluate a fluorographic myocardial staining index (MSI) during vein of Marshall ethanol infusion (VOM-EI) and examine its association with achieving mitral isthmus (MI) conduction block.
  • Retrospectively analyzed consecutive patients with persistent atrial fibrillation undergoing catheter ablation at a single Italian center between February 2022 and May 2023 (N=42 with identifiable VOM out of 49).
  • Calculated MSI from fluoroscopy images and evaluated its correlation with newly created low-voltage zones (LVZ) and successful MI conduction block.
  • MI conduction block was achieved in 83.3% (35/42) of patients and was significantly associated with higher MSI (OR 1.24, 95% CI 1.03–1.48; p = 0.022).
  • Higher MSI was associated with MI block achieved by endocardial ablation alone (OR 1.07, 95% CI 1.02–1.13; p = 0.002) and strongly correlated with newly formed LVZ extension (r = 0.776; p = 0.001).
  • Increased MSI significantly decreased the required ablation time (p = 0.014) and the number of radiofrequency applications (p = 0.002) needed to establish block.

Study Design

Type

Observational (n=42)

Multicenter

No

Structured PICO

Does a higher myocardial staining index during vein of Marshall ethanol infusion predict mitral isthmus block achievement in patients with persistent atrial fibrillation?

P
Population
42 patients with persistent atrial fibrillation and an identifiable vein of Marshall undergoing catheter ablation
I
Intervention
Quantitative assessment of myocardial staining (MSI) during retrograde ethanol infusion into the vein of Marshall
O
Outcome
Association of MSI with mitral isthmus (MI) block achievementsurrogate

Main Result

Effect estimate: OR 1.24 (95% CI 1.03-1.48)

p-value: p=0.022

A proposed quantitative index of myocardial staining during vein of Marshall ethanol infusion predicts successful mitral isthmus block and reduces required ablation time in patients with persistent atrial fibrillation.

Limitations

  • Small number of patients in the study population
  • Inclusion of both naïve patients and redo cases
  • Different means of investigation used during follow-up
  • Unstandardized antiarrhythmic drug regimens
  • Retrospective calculation of the myocardial staining index
  • Lack of prospective data on the correlation between MSI and durable scar formation

Cite This Study

Landra et al. (2024) conducted an observational in Persistent atrial fibrillation (PeAF) (n=42). Vein of Marshall ethanol infusion (VOM-EI) with myocardial staining index (MSI) assessment was evaluated on Occurrence of mitral isthmus (MI) block (OR 1.24, 95% CI 1.03-1.48, p=0.022). A higher myocardial staining index during vein of Marshall ethanol infusion was significantly associated with the achievement of mitral isthmus block (OR 1.24).

synapsesocial.com/papers/6a0f333968065d64b26c916ehttps://doi.org/10.1007/s10840-023-01732-4
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