Ethanol marshall bundle elimination, pulmonary vein isolation, and linear ablation for atrial fibrillation with or without heart failure

Figure 1. Flow chart of patients who had full record of heart function classification before AF catheter ablation plus EIVOM. AF, Atrial fibrillation; HF, Heart failure; EIVOM, Ethanol infusion of the vein of marshall.

Figure 2. Summary of the ablation strategy and details of success rate in each step. Statistically significant differences are indicated as *P < 0.05, **P < 0.01. Abbreviations: EIVOM, Ethanol infusion of the vein of marshall; VOM, vein of marshall; PVI, pulmonary vein isolation; MI, mitral isthmus.

Figure 3. (A) Kaplan–Meier graph showing cumulative survival from AF recurrence between patients with and without HF; (B) Kaplan–Meier graph showing cumulative survival from AF recurrence between patients with and without HF after matching; (C) Kaplan–Meier graph showing cumulative survival from overall HF between patients with and without HF. (D) Kaplan–Meier graph showing cumulative survival from overall HF between patients with and without HF after matching. Statistically significant differences are indicated as *P < 0.05, **P < 0.01, ***P < 0.001, ****P < 0.0001. Abbreviations: HF, Heart failure; HR, hazard ratio.

Figure 4. Kaplan–Meier graph showing cumulative survival from AF recurrence between patients with and without HF without AAD. Abbreviations: HF, Heart failure; HR, hazard ratio; AAD, anti-arrhythmic drugs.

Figure 5. (A) Kaplan–Meier graph showing cumulative survival from AF recurrence between HFrEF and non-HF patients; (B) Kaplan–Meier graph showing cumulative survival from AF recurrence between HFpEF and non-HF patients; (C) Kaplan–Meier graph showing cumulative survival from AF recurrence between HFpEF and HFrEF patients; (D) Kaplan–Meier graph showing cumulative survival from overall HF between HFrEF and HFpEF patients. Statistically significant differences are indicated as *P < 0.05, **P < 0.01, ***P < 0.001, ****P < 0.0001. Abbreviation: HF, Heart failure; HR, hazard ratio; HFrEF, Heart failure with reduced left ventricular ejection fractions; including all patients with left ventricular ejection fractions <50%. HFpEF, Heart failure with preserved left ventricular ejection fractions.

Figure 6. Hfref and HFpEF patients’ echocardiographic comparisons before and after AF ablation plus EIVOM: (A) left ventricular ejection fraction, (B) left atrial diameter, (C) left ventricular diameter, (D) right atrial diameter. Values shown are mean ± SD. P values were calculated by paired sample t-test. Statistically significant differences are indicated as ns, no significance, *P < 0.05, **P < 0.01, ***P < 0.001, ****P < 0.0001. Abbreviations: HFrEF, Heart failure with reduced left ventricular ejection fractions; including all patients with left ventricular ejection fractions <50%; HFpEF, Heart failure with preserved left ventricular ejection fractions; LVEF, Left ventricular ejection fraction; LAD, Left atrial diameter; LVEDD, Left ventricular end diastolic diameter; RAD, Right arial diameter.

Figure 7. Echocardiographic comparisons in recurrence and non-recurrence HF patients before and after AF ablation plus EIVOM: (A) left ventricular ejection fraction, (B) left atrial diameter, (C) left ventricular diameter, (D) right atrial diameter. Values shown are mean ± SD. P values were calculated by paired sample t-test. Statistically significant differences are indicated as ns, no significance, *P < 0.05, **P < 0.01, ***P < 0.001, ****P < 0.0001. Abbreviations: LVEF, Left ventricular ejection fraction; LAD, Left atrial diameter; LVEDD, Left ventricular end diastolic diameter; RAD, Right arial diameter.