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).
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?
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.
Hazard Ratio: 0.35
Absolute Event Rate: 18.8% vs 40.8%
p-value: p=0.018
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.
Takigawa et al. (Sun,) 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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