Ethanol infusion into the vein of Marshall reduced the need for LAPW debulking ablation compared to radiofrequency alone (60% vs 75%, p<.05) but did not improve clinical outcomes.
Cohort (n=413)
Does ethanol infusion into the vein of Marshall improve the efficacy and durability of left atrial posterior wall isolation in patients with atrial fibrillation undergoing ablation?
Ethanol infusion into the vein of Marshall reduces the need for LAPW debulking ablation but does not improve long-term clinical outcomes or durability of LAPW isolation compared to radiofrequency ablation alone.
Tasa de eventos absoluta: 60% vs 75%
valor p: p=<.05
INTRODUCTION: Ethanol infusion into the vein of Marshall (EIVOM) is expected to be an adjunctive therapy for mitral isthmus (MI) ablation. Additionally, EIVOM can widely ablate the epicardium via the branches that extend to the left atrial posterior wall (LAPW) and facilitate LAPW isolation. This study aimed to investigate the efficacy and durability of LAPW isolation with EIVOM. METHODS: Our cohort consisted of 413 patients with atrial fibrillation (AF) who underwent both LAPW and MI ablations. EIVOM was first attempted in 177 (35%) patients with adequate VOMs. The VOM was infused with 5 mL of ethanol with a double coaxial guiding catheter technique. Both ablations were performed only by radiofrequency ablation (the RF group) in the remaining 236 (57%) patients. RESULTS: EIVOM with 5 mL of ethanol was completely achieved in 106 patients (the EIVOM group). The application duration of LAPW isolation did not differ significantly between the two groups (718 ± 276 vs. 709 ± 288 s; p = .78). LAPW debulking ablation was required in 64/106 (60%) and 176/236 (75%) patients in the EIVOM and RF groups, respectively (p < .05). However, AF- or atrial tachycardia-free survival analyses revealed no significant differences between the two groups (log-rank p = .70). Among the cases of recurrence, 17 and 38 patients underwent subsequent ablation sessions; LAPW was reconnected in 9/17 (53%) and 25/38 (53%) patients (p = .36) in the EIVOM and RF groups, respectively. CONCLUSION: EIVOM reduced the number of cases that required LAPW debulking ablation but did not improve the durability of LAPW isolation or clinical outcomes.
Ishimura et al. (Mon,) conducted a cohort in Atrial fibrillation (AF) (n=413). Ethanol infusion into the vein of Marshall (EIVOM) vs. Radiofrequency ablation only was evaluated on Requirement for LAPW debulking ablation (p=<.05). Ethanol infusion into the vein of Marshall reduced the need for LAPW debulking ablation compared to radiofrequency alone (60% vs 75%, p<.05) but did not improve clinical outcomes.