Empirical Marshall vein ethanol infusion before catheter ablation significantly reduced long-term atrial tachycardia recurrence (HR 0.25) compared to provisional infusion in persistent AF patients.
Cohort (n=133)
No
Does empirical Marshall vein ethanol infusion reduce atrial tachycardia recurrence in patients with persistent atrial fibrillation undergoing mitral isthmus ablation?
Empirical Marshall vein ethanol infusion prior to mitral isthmus ablation reduces endocardial ablation time and improves long-term freedom from atrial tachycardia recurrence in patients with persistent atrial fibrillation.
Effect estimate: HR 0.25 (95% CI 0.07-0.92)
Absolute Event Rate: 95.8% vs 81.6%
p-value: p=0.037
Background Marshall vein ethanol infusion (MVEI) as an additional therapy to conventional catheter ablation (CA) has been proved to be efficacious in patients with persistent atrial fibrillation (PeAF). However, whether empirical MVEI could be the first-line strategy in mitral isthmus (MI) ablation has seldom been investigated. Here, we aim to compare the efficacy, safety, and long-term outcomes between provisional and empirical MVEI in PeAF patients undergoing the index MI ablation procedure. Methods We enrolled 133 patients with PeAF either in the provisional group ( n = 38, MVEI was performed when conventional endocardial and/or epicardial ablation procedures were inadequate to achieve bidirectional MI block) or in the empirical group ( n = 95, MVEI was performed empirically before MI CA). Results All of the baseline characteristics were comparable. Less spontaneous or inducible atrial tachycardias (ATs) were encountered in the empirical group of patients ( P 0.001). More epicardial ablations were applied (26.3% vs. 9.5%, P = 0.016) and a higher incidence of CA-facilitated restoration of sinus rhythm was recorded (86.8% vs. 11.7%, P 0.001) in the provisional group of patients. Although more fluoroscopy time (6.44.2, 9.3 vs. 9.55.9, 11.6 min, P = 0.019) and radiation exposure (69.025.3, 160.2 vs. 122.062.5, 234.1 mGy, P = 0.010) were documented in the empirical group with comparable procedure time, less time (455.9 ± 192.2 vs. 366.5 ± 161.3 s, P = 0.038) was consumed to achieve bidirectional MI block during endocardial ablation in the provisional group. Incidences of procedure-related complications were similar between the two groups. During a 16.5 ± 4.4-month follow-up, the empirical group of patients showed a significantly higher rate of freedom from AT recurrence (95.8% vs. 81.6%, log-rank P = 0.003), while the rate of freedom from AF or atrial tachyarrhythmias (combining AF and AT) was similar. Both univariate (HR 0.19, 95% CI 0.05–0.64, P = 0.008) and multivariate (HR 0.25, 95% CI 0.07–0.92, P = 0.037) Cox regression analyses indicated that empirical MVEI was independently associated with lower long-term AT recurrence. Conclusion Among patients with PeAF who underwent the index MI ablation procedure, empirical MVEI could reduce endocardial MI ablation time and provide greater long-term freedom from AT recurrence.
Du et al. (Tue,) conducted a cohort in Persistent atrial fibrillation (n=133). Empirical Marshall vein ethanol infusion vs. Provisional Marshall vein ethanol infusion was evaluated on Freedom from atrial tachycardia recurrence (HR 0.25, 95% CI 0.07-0.92, p=0.037). Empirical Marshall vein ethanol infusion before catheter ablation significantly reduced long-term atrial tachycardia recurrence (HR 0.25) compared to provisional infusion in persistent AF patients.