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November 3, 2023Journal of Clinical MedicineOpen Access

Impact of Vein of Marshall Ethanol Infusion Combined with Anatomical Ablation for the Treatment of Persistent Atrial Fibrillation: A Long-Term Follow-Up Based on Implantable Loop Recorders

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Why the study?

The optimal ablation strategy for persistent AF remains debated, and the vein of Marshall represents a promising ablation target.

Does a comprehensive ablation approach including vein of Marshall ethanol infusion prevent AT/AF recurrences in patients with persistent atrial fibrillation?

Population

31 consecutive patients undergoing first catheter ablation for persistent AF

Comparison

VOM ethanol infusion plus PVI, LA roofline, mitral line, and cavotricuspid isthmus line

Design

Single-center observational study

Follow-up

Mean 12 ± 7 months

Key result

Vein of Marshall ethanol infusion combined with anatomical ablation in patients with persistent atrial fibrillation resulted in 87% freedom from AF/AT recurrences at a mean 12-month follow-up.

Authors

MNMartina NestiElectrophysiologyFLFabiana LucàMetropolitan HospitalLPLuca PanchettiScan Foundation

Discussion

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Member takes

Overview

May support adjunctive vein of Marshall ethanol in persistent AF ablation; leaves open need for randomized confirmation.

Key Points

  • To evaluate the recurrence rate of atrial fibrillation in persistent atrial fibrillation patients treated with vein of Marshall ethanol infusion alongside comprehensive linear anatomical ablation.
  • Enrolled 31 consecutive patients (mean age 66 ± 8 years, 71% male) undergoing first-time catheter ablation for persistent atrial fibrillation.
  • Performed vein of Marshall ethanol infusion combined with pulmonary vein isolation, left atrial roofline, mitral line, and cavotricuspid isthmus line ablation, followed by continuous monitoring via implantable loop recorders for 12 ± 7 months.
  • Freedom from atrial fibrillation or atrial tachycardia recurrence was achieved in 27 out of 31 patients (87%) at a mean follow-up of 12 ± 7 months.
  • Antiarrhythmic drugs were discontinued in 23 out of 31 patients (74%) after 1 month of follow-up, and no significant procedural complications were observed.

Study Design

Type

Observational (n=31)

Multicenter

No

Structured PICO

Does a comprehensive ablation approach including vein of Marshall ethanol infusion prevent AT/AF recurrences in patients with persistent atrial fibrillation?

P
Population
31 consecutive patients (mean age 66 ± 8 years, 71% male) undergoing their first catheter ablation procedure for persistent atrial fibrillation (PeAF).
I
Intervention
Comprehensive ablation approach consisting of vein of Marshall (VOM) ethanol infusion, pulmonary vein isolation (PVI), a left atrial roofline, a mitral line, and a cavotricuspid isthmus line, followed by implantable loop recorder (ILR) implantation.
O
Outcome
Incidence of atrial tachycardia/atrial fibrillation (AT/AF) recurrences evaluated by implantable loop recorder at a mean follow-up of 12 ± 7 months.hard clinical

A comprehensive ablation strategy incorporating vein of Marshall ethanol infusion and anatomical lines is safe and highly effective, achieving 87% freedom from arrhythmia recurrence at 1 year in patients with persistent atrial fibrillation.

Limitations

  • single-center experience

Cite This Study

Nesti et al. (2023) conducted an observational in persistent atrial fibrillation (PeAF) (n=31). Vein of Marshall ethanol infusion combined with anatomical ablation was evaluated on freedom from AT/AF recurrences. Vein of Marshall ethanol infusion combined with anatomical ablation in patients with persistent atrial fibrillation resulted in 87% freedom from AF/AT recurrences at a mean 12-month follow-up.

synapsesocial.com/papers/6a0fcf2f57bfcc72645fbb40https://doi.org/10.3390/jcm12216916
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Cryoballoon or Radiofrequency Ablation for Atrial Fibrillation Assessed by Continuous Monitoring2019 · 574 citations
  2. 2Pulmonary Vein Antrum Isolation:2004 · 321 citations
  3. 3Adjunctive Vein of Marshall Ethanol Infusion During Atrial Fibrillation Ablation: A Systematic Review and Meta-Analysis2020 · 9 citations
  4. 4Effect of Catheter Ablation With Vein of Marshall Ethanol Infusion vs Catheter Ablation Alone on Persistent Atrial Fibrillation2020 · 367 citations
  5. 5Approaches to Catheter Ablation for Persistent Atrial Fibrillation2015 · 2,334 citations