What question did this study set out to answer?

To assess the feasibility and clinical efficacy of ethanol infusion into the vein of Marshall (EI-VOM) for treating recurrent perimitral atrial tachycardia (PMAT) following catheter ablation for persistent atrial fibrillation.

August 28, 2020Pacing and Clinical Electrophysiology

Ethanol infusion into the vein of Marshall for recurrent perimitral atrial tachycardia after catheter ablation for persistent atrial fibrillation

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Why the study?

Catheter ablation of PMAT is challenging, with epicardial Marshall bundle conduction across the mitral isthmus causing recurrences, and the role of EI-VOM has not been fully elucidated.

Does ethanol infusion into the vein of Marshall improve procedural success and reduce recurrence in patients with recurrent perimitral atrial tachycardia after AF ablation?

Key Points

To assess the feasibility and clinical efficacy of ethanol infusion into the vein of Marshall (EI-VOM) for treating recurrent perimitral atrial tachycardia (PMAT) following catheter ablation for persistent atrial fibrillation.
Enrolled 28 consecutive patients presenting with recurrent PMAT after catheter ablation for persistent atrial fibrillation.
Diagnosed conventional PMAT (group 1, n = 15) and Marshall bundle (MB)-related PMAT (group 2, n = 13) using high-density activation and entrainment mapping.
Performed VOM venography and EI-VOM as the initial strategy, followed by supplemental radiofrequency ablation if residual conduction across the mitral isthmus persisted.
The vein of Marshall was successfully cannulated in 85.7% (24/28) of patients (80% [12/15] in group 1 vs 92.3% [12/13] in group 2).
Acute procedural response (arrhythmia termination or cycle length prolongation) occurred significantly more often in MB-related PMAT than conventional PMAT (92.4% vs 53.3%, P = .038).
Bidirectional mitral isthmus block was achieved in 93.3% (14/15) of group 1 and 92.3% (12/13) of group 2 (P = 1.000), with 10.7% (3/28) experiencing atrial tachycardia recurrence over a mean follow-up of 7.5 ± 3.1 months.

Structured PICO

Does ethanol infusion into the vein of Marshall improve procedural success and reduce recurrence in patients with recurrent perimitral atrial tachycardia after AF ablation?

Population

28 consecutive patients with recurrent perimitral atrial tachycardia (PMAT) after atrial fibrillation (AF) ablation, including 15 with conventional PMAT and 13 with Marshall bundle (MB)-related PMAT.

Intervention

Ethanol infusion into the vein of Marshall (EI-VOM) followed by additional ablation if necessary.

Outcome

Responsiveness to EI-VOM (defined as PMAT termination or tachycardia cycle length prolongation) and mitral isthmus (MI) bidirectional block.surrogate

Ethanol infusion into the vein of Marshall is a feasible and effective strategy for treating recurrent perimitral atrial tachycardia after AF ablation, particularly for Marshall bundle-related PMAT.

Discussion

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Implication

EI-VOM feasible for recurrent PMAT; leaves open its adjunctive role pending larger prospective studies.

Cite This Study

Sang et al. (2020) studied this question.

synapsesocial.com/papers/6a7cea14a7506f21e35dfffc https://doi.org/10.1111/pace.14052

Topics

Atrial fibrillation Persistent AF management AF ablation outcomes

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Ethanol infusion into the vein of Marshall for recurrent perimitral atrial tachycardia after catheter ablation for persistent atrial fibrillation

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

Ethanol infusion into the vein of Marshall for recurrent perimitral atrial tachycardia after catheter ablation for persistent atrial fibrillation

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider