Key result
Ethanol infusion in the vein of Marshall prior to radiofrequency ablation significantly reduced 1-year atrial tachycardia recurrence compared to RF ablation alone (18.8% vs 40.8%; HR 0.35, P=0.018).
Why the study?
It was hypothesized that an epicardial approach using ethanol infusion in the vein of Marshall may improve the results of ablation for perimitral flutter.
Does ethanol infusion in the vein of Marshall followed by RF ablation improve acute termination and reduce 1-year recurrence compared to RF ablation alone in patients with perimitral flutter?
Cohort (n=103)
Does ethanol infusion in the vein of Marshall followed by RF ablation improve acute termination and reduce 1-year recurrence compared to RF ablation alone in patients with perimitral flutter?
Hazard Ratio: 0.35
Absolute Event Rate: 18.8% vs 40.8%
p-value: p=0.018
Ethanol infusion in the vein of Marshall combined with RF ablation reduces required RF duration and improves 1-year freedom from recurrence in patients with perimitral flutter compared to RF ablation alone.
EIVOM adjunct to RF ablation was associated with lower AT recurrence; hypothesis-generating and requires randomized confirmation before practice change.
AIMS: We hypothesized that an epicardial approach using ethanol infusion in the vein of Marshall (EIVOM) may improve the result of ablation for perimitral flutter (PMF). METHODS AND RESULTS: We studied 103 consecutive patients with PMF undergoing high-resolution mapping. The first 71 were treated with radiofrequency (RF) ablation alone (RF-group), and the next 32 underwent EIVOM followed by RF on the endocardial and epicardial mitral isthmus (EIVOM/RF-group). Contact force was not measured during ablation. Acute and 1-year outcomes were compared. Flutter termination rates were similar between the RF-group (63/71, 88.7%) and EIVOM/RF-group (31/32, 96.8%, P = 0.27). Atrial tachycardia (AT) terminated with EIVOM alone in 22/32 (68.6%) in the EIVOM/RF-group. Bidirectional block of mitral isthmus was always achieved in the EIVOM/RF-group, but significantly less frequently achieved in the RF-group (62/71, 87.3%; P = 0.05). Median RF duration for AT termination/conversion was shorter [0 (0-6) s in the EIVOM/RF-group than 312 (55-610) s in the RF-group, P < 0.0001], as well as for mitral isthmus block in the EIVOM/RF-group [246 (0-663) s] than in the RF-group [900 (525-1310) s, P < 0.0001]. Pericardial effusion was observed in 1/32 (3.2%) in EIVOM/RF-group and 5/71 (7.0%) in RF-group (P = 0.66); two in RF-group required drainage and one of them developed subsequent ischaemic stroke. One-year follow-up demonstrated fewer recurrences in the EIVOM/RF-group [6/32 (18.8%)] than in the RF-group [29/71 (40.8%), P = 0.04]. By multivariate analysis, only EIVOM was significantly associated with less AT recurrence (hazard ratio = 0.35, P = 0.018). CONCLUSION: Ethanol infusion in the vein of Marshall may reduce RF duration required for PMF termination as well as for mitral isthmus block without severe complications, and the mid-term outcome may be improved by this approach.
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Takigawa et al. (2020) conducted a cohort in perimitral flutter (n=103). Ethanol infusion in the vein of Marshall (EIVOM) followed by RF ablation vs. Radiofrequency (RF) ablation alone was evaluated on Atrial tachycardia recurrence at 1 year (HR 0.35, p=0.018). Ethanol infusion in the vein of Marshall prior to radiofrequency ablation significantly reduced 1-year atrial tachycardia recurrence compared to RF ablation alone (18.8% vs 40.8%; HR 0.35, P=0.018).
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