A novel stepwise approach incorporating ethanol infusion in the vein of Marshall for the ablation of persistent atrial fibrillation

Frontiers in Cardiovascular Medicine

Cardiovascular Medicine

Sarah Zeriouh¹  Roberto Menè¹  Stéphane Combes¹  Christelle Cardin¹  Serge Boveda¹  Nicolas Combes¹  Pauline Pinon¹  Jean Paul Albenque¹  Vasileios Sousonis¹  Sophie Jacob² 

[1] Heart Rhythm Management Department, Clinique, Pasteur, Toulouse, France;Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France;

关键词: atrial fibrillation;    persistent, ablation;    ethanol;    vein of Marshall;   

DOI  :  10.3389/fcvm.2023.1194687

 received in 2023-03-27, accepted in 2023-04-27,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionApart from pulmonary vein isolation (PVI), several step-by-step procedures that aim to modify left atrial substrate have been proposed for the ablation of persistent atrial fibrillation (AF), yet the optimal strategy remains elusive. There are cumulative data suggesting an incremental benefit of adding vein of Marshall (VOM) ethanol infusion to PVI in patients with persistent AF. We sought to evaluate the feasibility and efficacy of a novel stepwise ablation approach, incorporating a VOM alcoholization step, for persistent AF.MethodsIn this single-center study, we prospectively enrolled 66 consecutive patients with symptomatic persistent AF and failure of at least one antiarrhythmic drug (ADD). The ablation procedure consisted of (i) PVI, (ii) left atrial segmentation with VOM ethanol infusion and the deployment of linear radiofrequency lesions across the roof and the mitral isthmus and (iii) electrogram-based ablation of dispersion zones. The first two steps were performed in all patients, whereas the third step was carried out only in those still in AF at the end of the second step. Atrial tachycardias during the procedure were mapped and ablated. At the end of the procedure, cavotricuspid isthmus ablation was additionally performed in all patients. The primary endpoint was 12-month freedom from AF and atrial tachycardia after a single procedure and an initial three-month blanking period.ResultsTotal procedure time was 153 ± 38.5 min. Fluoroscopy time was 16 ± 6.5 min and the radiofrequency ablation time was 26.14 ± 0.26 min. The primary endpoint occurred in 54 patients (82%). At 12 months, 65% of patients were off any AAD. In the univariate Cox regression analysis, left ventricular ejection fraction < 40% was the only predictor of arrhythmia recurrence (HR 3.56; 95% CI, 1.04–12.19; p = 0.04). One patient developed a pericardial tamponade and another a minor groin hematoma.ConclusionA novel stepwise approach, including a step of ethanol infusion in the VOM, is feasible, safe and provides a high rate of sinus rhythm maintenance at 12 months in patients with persistent AF.

【 授权许可】

Unknown   
© 2023 Sousonis, Combes, Pinon, Combes, Cardin, Zeriouh, Menè, Jacob, Boveda and Albenque.