Key result
The 'upgraded 2C3L' approach was associated with a significantly lower recurrence rate of AF/AT 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 rates for persistent AF due to incomplete block of ablation lines, particularly at the mitral isthmus.
Does ethanol infusion into the vein of Marshall combined with RF ablation improve freedom from AF/AT compared to RF ablation alone in patients with persistent atrial fibrillation?
Cohort (n=191)
Does ethanol infusion into the vein of Marshall combined with RF ablation improve freedom from AF/AT compared to RF ablation alone in patients with persistent atrial fibrillation?
Hazard Ratio: 0.27 (95% CI 0.12–0.59)
Absolute Event Rate: 87.9% vs 64.8%
p-value: p=<0.001
The addition of ethanol infusion into the vein of Marshall to a fixed anatomical RF ablation strategy significantly improves 12-month freedom from atrial arrhythmias in patients with persistent atrial fibrillation.
May facilitate mitral isthmus block in PeAF ablation; leaves open whether it improves outcomes in randomized trials.
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, EI-VOM was firstly 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 group 1 and 2, respectively (p=0.006). Patients in group 1 had shorter ablation time for left pulmonary vein antrum (8.15 min vs 12.59 min, p<0.001) and MI (7.0 min vs 11.8 min, p<0.001) and required less cardioversion (50(78.5%) vs 113(90.4%), p=0.007). During the 12-month follow-up, 58 (87.9%) patients were free from AF/AT in group 1 compared with 81 (64.8%) in group 2 (p<0.001). In multivariate cox regression, the ‘upgraded 2C3L’ procedure is associated with a lower recurrence rate (HR 0.27, 95%CI 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 (PeAF) (n=191). Ethanol infusion into the vein of Marshall combined with a fixed anatomical ablation strategy ('upgraded 2C3L') vs. Conventional '2C3L' approach (PVAI and three linear ablations using only RF energy) was evaluated on Freedom from AF/AT at 12 months (HR 0.27, 95% CI 0.12-0.59, p=<0.001). The 'upgraded 2C3L' approach was associated with a significantly lower recurrence rate of AF/AT compared to conventional RF ablation (HR 0.27; 95% CI 0.12-0.59).
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