Key result
The 'upgraded 2C3L' approach was associated with a lower recurrence rate of atrial fibrillation or tachycardia compared to conventional RF ablation (HR 0.27; 95% CI 0.12-0.59).
Why the study?
Linear ablation added to PVAI has failed to improve success in persistent AF due to incomplete ablation line block, especially at the mitral isthmus.
Does ethanol infusion into the vein of Marshall combined with a fixed anatomical ablation strategy improve freedom from atrial arrhythmias in patients with persistent atrial fibrillation compared to conventional RF ablation?
Cohort (n=191)
Does ethanol infusion into the vein of Marshall combined with a fixed anatomical ablation strategy improve freedom from atrial arrhythmias in patients with persistent atrial fibrillation compared to conventional RF ablation?
The addition of ethanol infusion into the vein of Marshall to a fixed anatomical ablation strategy significantly improves mitral isthmus block and freedom from atrial arrhythmias in patients with persistent atrial fibrillation.
Answers are grounded in this paper and cite their sources.
May support vein of Marshall ethanol as adjunct in persistent AF ablation; hypothesis-generating pending randomized confirmation.
INTRODUCTION: Linear ablation in addition to pulmonary vein antrum isolation (PVAI) has failed to improve the success rate for persistent atrial fibrillation (PeAF), due to incomplete block of ablation lines, especially in the mitral isthmus (MI). METHODS AND RESULTS: The study enrolled 191 patients (66 in group 1 and 125 in group 2). In group 1, ethanol infusion into the vein of Marshall was first performed, followed by radiofrequency (RF) applications targeting bilateral PVAI and bidirectional block in the roofline, cavotricuspid isthmus, and MI. In group 2, PVAI and the three linear ablations were completed using only RF energy. MI block was achieved in 63 (95.5%) and 101 (80.8%) patients in groups 1 and 2, respectively (p = .006). Patients in group 1 had shorter ablation time for left pulmonary vein antrum (8.15 vs. 12.59 min, p < .001) and MI (7.0 vs. 11.8 min, p < .001) and required less cardioversion (50 [78.5%] vs. 113 [90.4%], p = .007). During the 12-month follow-up, 58 (87.9%) patients were free from atrial fibrillation/atrial tachycardia in group 1 compared with 81 (64.8%) in group 2 (p < .001). In multivariate cox regression, the "upgraded 2C3L" procedure is associated with a lower recurrence rate (hazard ratio = 0.27, 95% confidence interval = 0.12-0.59). CONCLUSION: Compared with the conventional "2C3L" approach, the "upgraded 2C3L" approach has higher effectiveness for ablation of PeAF.
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Lai et al. (2021) conducted a cohort in Persistent atrial fibrillation (n=191). Ethanol infusion into the vein of Marshall combined with a fixed anatomical ablation strategy ('upgraded 2C3L' approach) vs. Conventional '2C3L' approach (PVAI and three linear ablations using only RF energy) was evaluated on Freedom from atrial fibrillation/atrial tachycardia (HR 0.27, 95% CI 0.12-0.59, p=<0.001). The 'upgraded 2C3L' approach was associated with a lower recurrence rate of atrial fibrillation or tachycardia compared to conventional RF ablation (HR 0.27; 95% CI 0.12-0.59).
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