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O’Neill L, De Becker B, De Smet M, Francois C, Tavernier R, Duytschaever M, Le Polain De Waroux JB, Knecht S. Vein of Marshall Ethanol Infusion for AF Ablation; A Review. J Clin Med 2024; 13:2438. [PMID: 38673710 PMCID: PMC11050818 DOI: 10.3390/jcm13082438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/14/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
The outcomes of persistent atrial fibrillation (AF) ablation are modest with various adjunctive strategies beyond pulmonary vein isolation (PVI) yielding largely disappointing results in randomised controlled trials. Linear ablation is a commonly employed adjunct strategy but is limited by difficulty in achieving durable bidirectional block, particularly at the mitral isthmus. Epicardial connections play a role in AF initiation and perpetuation. The ligament of Marshall has been implicated as a source of AF triggers and is known to harbour sympathetic and parasympathetic nerve fibres that contribute to AF perpetuation. Ethanol infusion into the Vein of Marshall, a remnant of the superior vena cava and key component of the ligament of Marshall, may eliminate these AF triggers and can facilitate the ease of obtaining durable mitral isthmus block. While early trials have demonstrated the potential of Vein of Marshall 'ethanolisation' to reduce arrhythmia recurrence after persistent AF ablation, further randomised trials are needed to fully determine the potential long-term outcome benefits afforded by this technique.
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Affiliation(s)
- Louisa O’Neill
- Department of Cardiology, AZ Sint-Jan Hospital, 8000 Bruges, Belgium; (B.D.B.); (S.K.)
- Department of Cardiology, Blackrock Clinic, A94 E4X7 Dublin, Ireland
- King’s College London, St. Thomas’ Hospital, London SE1 9NH, UK
| | - Benjamin De Becker
- Department of Cardiology, AZ Sint-Jan Hospital, 8000 Bruges, Belgium; (B.D.B.); (S.K.)
| | - Maarten De Smet
- Department of Cardiology, AZ Sint-Jan Hospital, 8000 Bruges, Belgium; (B.D.B.); (S.K.)
| | - Clara Francois
- Department of Cardiology, AZ Sint-Jan Hospital, 8000 Bruges, Belgium; (B.D.B.); (S.K.)
| | - Rene Tavernier
- Department of Cardiology, AZ Sint-Jan Hospital, 8000 Bruges, Belgium; (B.D.B.); (S.K.)
| | - Mattias Duytschaever
- Department of Cardiology, AZ Sint-Jan Hospital, 8000 Bruges, Belgium; (B.D.B.); (S.K.)
| | | | - Sebastien Knecht
- Department of Cardiology, AZ Sint-Jan Hospital, 8000 Bruges, Belgium; (B.D.B.); (S.K.)
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2
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Tzeis S, Gerstenfeld EP, Kalman J, Saad E, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01771-5. [PMID: 38609733 DOI: 10.1007/s10840-024-01771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society (HRS), the Asia Pacific HRS, and the Latin American HRS.
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Affiliation(s)
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | - Gregory F Michaud
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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3
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2024:S1547-5271(24)00261-3. [PMID: 38597857 DOI: 10.1016/j.hrthm.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society.
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece.
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil; Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France; Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain; Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Case Western Reserve University, Cleveland, OH, USA; Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA; Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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4
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Zuo S, Sang C, Long D, Bo X, Lai Y, Guo Q, Wang Y, Li M, He L, Zhao X, Guo X, Liu N, Li S, Wang W, Jiang C, Tang R, Du X, Dong J, Ma C. Efficiency and Durability of EIVOM on Acute Reconnection After Mitral Isthmus Bidirectional Block. JACC Clin Electrophysiol 2024; 10:685-694. [PMID: 38658060 DOI: 10.1016/j.jacep.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 04/26/2024]
Abstract
BACKGROUND Reconnection after mitral isthmus (MI) block with radiofrequency ablation is common. OBJECTIVES The aim of this study was to investigate the effects of ethanol infusion in the vein of Marshall (EIVOM) on acute reconnection after MI bidirectional block. METHODS Patients with persistent atrial fibrillation who were scheduled to receive radiofrequency ablation for the first time were randomly assigned to the radiofrequency catheter ablation (RFCA) group (n = 44) or the EIVOM group (n = 45). The RFCA group's strategy was bilateral pulmonary vein ablation and linear ablation; in the EIVOM group, EIVOM was performed first. The primary endpoint was acute reconnection 30 minutes after MI bidirectional block. RESULTS A total of 89 patients (average age 62.9 years; 57.3% male) were enrolled. The average duration for persistent atrial fibrillation was 2.3 years. Before observation, all patients in the EIVOM group achieved MI bidirectional block (45 of 45 [100%]), compared with 84.1% (37 of 44) in the RFCA group. After the observation, 3 cases of MI reconnection occurred in the EIVOM group and 13 cases in the RFCA group (6.7% vs 35.1%; P < 0.05). After additional ablation, the final MI block rates in the EIVOM and RFCA groups were 97.8% (44 of 45) and 72.7% (32 of 44), respectively. During a 1-year follow-up, 8 of 45 patients who underwent EIVOM had recurrent atrial fibrillation, compared with 14 of 44 in the RFCA group (17.8% vs 31.8%; P < 0.01). CONCLUSIONS EIVOM can reduce acute reconnection after MI bidirectional block and significantly increase first-pass MI block.
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Affiliation(s)
- Song Zuo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Caihua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Deyong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xiaowen Bo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Yiwei Lai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Qi Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Yufeng Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Mengmeng Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Liu He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xueyuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Songnan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Wei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Chenxi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
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5
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Kawaguchi N, Tanaka Y, Okubo K, Tachibana S, Nakashima E, Takagi K, Hikita H, Sasano T, Takahashi A. Differential Pacing Maneuver From the Vein of Marshall. Circ Arrhythm Electrophysiol 2024; 17:e012420. [PMID: 38390725 DOI: 10.1161/circep.123.012420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Bidirectional mitral isthmus (MI) block is conventionally verified by differential pacing from the coronary sinus (CS) and its sequence change. This study aimed to evaluate the ability of differential pacing from the vein of Marshall (VOM) to detect epicardial MI connections. METHODS Radiofrequency and VOM ethanol MI ablation were performed with a VOM electrode catheter inserted to the septal side of the ablation line. MI block was verified using conventional CS pacing. To perform differential VOM pacing analysis, initial pacing was delivered from a distal VOM bipole closer to the block line, and then from a proximal VOM bipole. The intervals from pacing stimulus during different VOM pacing sites to the electrogram recorded through the CS catheter on the opposite side of the line were compared. When the interval during distal VOM pacing was longer than that during proximal VOM pacing, it indicated a VOM connection block; however, if the former interval was shorter, the connection through the VOM was considered persistent. RESULTS Overall, 50 patients were evaluated. According to CS pacing, MI ablation was incomplete in 9 patients, in whom the analysis indicated persistent VOM connection. Among 41 patients with complete MI block, confirmed by CS finding, in 30 (73%) patients, the interval during distal VOM pacing was longer than that during proximal VOM pacing by 11±5 ms. However, in 11 patients (27%) the former interval was revealed to be shorter than the latter by 16±8 ms, indicating residual VOM connection. Conduction time across the line was significantly shorter in 11 patients than in the other 30 (166±21 versus 197±36 ms; P<0.01). Ten successful reevaluated analyses after VOM ethanol and further radiofrequency ablation of the connection indicated VOM block achievement. CONCLUSIONS Differential VOM pacing maneuver reflects the VOM conduction status. This maneuver can uncover residual epicardial connections that are missing with CS pacing.
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Affiliation(s)
- Naohiko Kawaguchi
- Cardiovascular Center, Yokosuka Kyosai Hospital, Japan (N.K., Y.T., K.O., S.T., E.N., K.T., H.H., A.T.)
| | - Yasuaki Tanaka
- Cardiovascular Center, Yokosuka Kyosai Hospital, Japan (N.K., Y.T., K.O., S.T., E.N., K.T., H.H., A.T.)
| | - Kenji Okubo
- Cardiovascular Center, Yokosuka Kyosai Hospital, Japan (N.K., Y.T., K.O., S.T., E.N., K.T., H.H., A.T.)
| | - Shinichi Tachibana
- Cardiovascular Center, Yokosuka Kyosai Hospital, Japan (N.K., Y.T., K.O., S.T., E.N., K.T., H.H., A.T.)
| | - Emiko Nakashima
- Cardiovascular Center, Yokosuka Kyosai Hospital, Japan (N.K., Y.T., K.O., S.T., E.N., K.T., H.H., A.T.)
| | - Katsumasa Takagi
- Cardiovascular Center, Yokosuka Kyosai Hospital, Japan (N.K., Y.T., K.O., S.T., E.N., K.T., H.H., A.T.)
| | - Hiroyuki Hikita
- Cardiovascular Center, Yokosuka Kyosai Hospital, Japan (N.K., Y.T., K.O., S.T., E.N., K.T., H.H., A.T.)
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (T.S.)
| | - Atsushi Takahashi
- Cardiovascular Center, Yokosuka Kyosai Hospital, Japan (N.K., Y.T., K.O., S.T., E.N., K.T., H.H., A.T.)
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6
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Sepehri Shamloo A, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O’Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2024; 26:euae043. [PMID: 38587017 PMCID: PMC11000153 DOI: 10.1093/europace/euae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 04/09/2024] Open
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología ‘Ignacio Chávez’, Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O’Neill
- Cardiovascular Directorate, St. Thomas’ Hospital and King’s College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Shimizu Y, Yoshitani K, Kuriyama T, Mori K, Kujira K, Imai M, Fukuhara R, Taniguchi R, Toma M, Miyamoto T, Sato Y. The effect of an initial catheter ablation with an adjunctive ethanol infusion into the vein of Marshall on persistent atrial fibrillation. J Cardiovasc Electrophysiol 2024; 35:453-460. [PMID: 38282242 DOI: 10.1111/jce.16191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/03/2024] [Accepted: 01/12/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION Some previous studies have reported that a first-step ethanol infusion into the vein of Marshall (EIVOM) with touch-up radiofrequency (RF) ablation can facilitate mitral isthmus (MI) block and improves the ablation outcomes in persistent atrial fibrillation (PeAF) patients. However, the effect of an initial RF ablation with an adjunctive EIVOM has not been fully investigated. METHODS This study enrolled 233 PeAF patients undergoing pulmonary vein isolation and linear ablation including an MI, roof line, and cavotricuspid isthmus ablation. An EIVOM was performed when endocardial ablation with or without coronary sinus ablation failed to create MI block. RESULTS Bidirectional MI block was achieved in 224 patients (96.1%). Among them, MI block was obtained by only RF ablation in 174/224 patients (77.7%) (RF group) and an adjunctive EIVOM was needed in 50/224 (22.3%) (EIVOM group). During the follow-up, 113 (64.9%) RF group patients were free from AF/atrial tachycardia compared to 41 (82.0%) EIVOM group patients (log-rank p = .045). In a multivariate Cox regression analysis, an adjunctive EIVOM was associated with a lower recurrence rate (hazard ratio = 0.39, 95% confidence interval = 0.17-0.78, p = .006). CONCLUSION An initial RF ablation with an adjunctive EIVOM strategy improved MI ablation's acute success rate and was associated with better clinical outcomes.
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Affiliation(s)
- Yukiko Shimizu
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | | | - Tomoari Kuriyama
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Kazuki Mori
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Kazuto Kujira
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Masao Imai
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Rei Fukuhara
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Tadashi Miyamoto
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
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8
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Ge WL, Lu YF, Li T, Wang Y, Yin J, Li XR, Jiang JJ, Mi YF, Tung TH, Yan SH. Clinical effect of vein of Marshall ethanol infusion on mitral isthmus ablation. Front Cardiovasc Med 2024; 11:1253554. [PMID: 38374993 PMCID: PMC10875083 DOI: 10.3389/fcvm.2024.1253554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/08/2024] [Indexed: 02/21/2024] Open
Abstract
Purpose This study aimed to investigate the effect of Marshall ethanol infusion (VOM-Et) in the vein on mitral isthmus (MI) ablation. Methods Patients with persistent atrial fibrillation (AF) were grouped into vein of VOM-Et combined with radiofrequency (RF) ablation (VOM-Et-RF) and RF groups. The primary outcome was MI block immediate block rate after surgery. Stratified analysis was also performed for factors affecting the outcome measures. Results A total of 118 consecutive patients underwent AF ablation at Taizhou Hospital of Zhejiang Province from January 2018 to December 2021. Successful bidirectional perimitral block was achieved in 96% of patients in VOM-Et-RF (69 of 72) and in 76% of patients in the RF group (35 of 46) (P < 0.01). In the subgroup analysis, male sex, elder than 60 years, Left atrial diameter <55 mm, and AF duration <3 years were associated with the benefits of VOM-Et in AF Patients. Conclusion The vein of Marshall ethanol infusion for catheter ablation can improve the MI block rate. Male sex, elder age, smaller Left atrial diameter and shorter AF duration may have significant benefits for VOM-Et.
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Affiliation(s)
- Wei-Li Ge
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
- Department of Cardiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Yi-Fei Lu
- Department of Cardiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Tao Li
- Department of Cardiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Ye Wang
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Jie Yin
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Xin-Ran Li
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Jian-Jun Jiang
- Department of Cardiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Ya-Fei Mi
- Department of Cardiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Tao-Hsin Tung
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China
- Key Laboratory of Evidence-Based Radiology of Taizhou, Linhai, Zhejiang, China
| | - Su-Hua Yan
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Jinan, China
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9
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Hasebe H, Yoshida K. Perimitral conduction time: Check it before creating an empirical mitral isthmus block. J Cardiovasc Electrophysiol 2024; 35:360-361. [PMID: 38234018 DOI: 10.1111/jce.16189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Affiliation(s)
- Hideyuki Hasebe
- Division of Arrhythmology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kentaro Yoshida
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama, Japan
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10
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Andronache M, Pastorcici A, Amet D, Blendea D, Boudias A, Mazieres G, Rosu R, Cismaru G, Puiu M, Mot S, Serban A, Mottref P, Dauphin C, Moini C, Lellouche N, Massoulié G. Acute mitral isthmus block during catheter ablation with vein of Marshall ethanol infusion: Angiographic considerations. Arch Cardiovasc Dis 2024; 117:119-127. [PMID: 38040560 DOI: 10.1016/j.acvd.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/26/2023] [Accepted: 11/06/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Achieving bidirectional mitral isthmus block is still challenging. Conventional ablation methods involve radiofrequency applications on the endocardial aspect of the lateral mitral isthmus, and often epicardial applications inside the coronary sinus. AIM To evaluate the impact of the systematic use of ethanol infusion in the vein of Marshall on the achievement of acute mitral isthmus block of additional epicardial component lesion. METHODS We evaluated patients referred to two centres for long-standing persistent atrial fibrillation ablation or recurrent peri-mitral flutter. All patients had pulmonary vein isolation and mitral isthmus line using ethanol infusion in the vein of Marshall for the first procedure and additional radiofrequency ablation lesion if necessary. For redo procedures, additional ablations (atrial lines and complex fractionated atrial electrogram ablations, if needed) were also performed. RESULTS We included 149 patients, and ethanol infusion in the vein of Marshall was not performed in 27 patients (18%). Among 122 patients, 115 had long-standing persistent atrial fibrillation (94.2%) and seven had peri-mitral flutter (5.8%). The mean duration of continuous atrial fibrillation was 53 months before ablation. Acute bidirectional mitral isthmus block was obtained in 115 (94.2%) of the 122 patients who received ethanol infusion in the vein of Marshall (77% when considering the total population). The mean radiofrequency delivery time to obtain mitral isthmus block was 2.6minutes for the endocardial mitral isthmus radiofrequency ablation and 2.6minutes for the epicardial mitral isthmus radiofrequency ablation. Failure to obtain mitral isthmus block was associated with increased mitral isthmus length and left atrial dilation. No major complications related to ethanol infusion in the vein of Marshall were observed. CONCLUSION Ethanol infusion in the vein of Marshall, when feasible (82%), was a safe approach to obtaining a high success rate (94%) of acute bidirectional endocardial and epicardial mitral isthmus block.
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Affiliation(s)
- Marius Andronache
- Cardiology Department, CHU Clermont-Ferrand, Clermont University, 63003 Clermont-Ferrand cedex 1, France; Alleray-Labrouste Cardiology Clinics, 75015 Paris, France
| | - Anda Pastorcici
- Cardiology Department, CHU Clermont-Ferrand, Clermont University, 63003 Clermont-Ferrand cedex 1, France
| | - Denis Amet
- Alleray-Labrouste Cardiology Clinics, 75015 Paris, France; Cardiology Department, Georges Pompidou European Hospital, 75015 Paris, France
| | - Dan Blendea
- Cardiology Department, University of Medicine and Pharmacy "Iuliu Hatieganu", 400394 Cluj-Napoca, Romania
| | - Antoine Boudias
- Cardiology Department, CHU Clermont-Ferrand, Clermont University, 63003 Clermont-Ferrand cedex 1, France
| | - Guillaume Mazieres
- Cardiology Department, CHU Clermont-Ferrand, Clermont University, 63003 Clermont-Ferrand cedex 1, France
| | - Radu Rosu
- Cardiology Department, University of Medicine and Pharmacy "Iuliu Hatieganu", 400394 Cluj-Napoca, Romania
| | - Gabriel Cismaru
- Cardiology Department, University of Medicine and Pharmacy "Iuliu Hatieganu", 400394 Cluj-Napoca, Romania
| | - Mihai Puiu
- Cardiology Department, University of Medicine and Pharmacy "Iuliu Hatieganu", 400394 Cluj-Napoca, Romania
| | - Stefan Mot
- Cardiology Department, University of Medicine and Pharmacy "Iuliu Hatieganu", 400394 Cluj-Napoca, Romania
| | - Adela Serban
- Cardiology Department, University of Medicine and Pharmacy "Iuliu Hatieganu", 400394 Cluj-Napoca, Romania
| | - Pascal Mottref
- Cardiology Department, CHU Clermont-Ferrand, Clermont University, 63003 Clermont-Ferrand cedex 1, France
| | - Claire Dauphin
- Cardiology Department, CHU Clermont-Ferrand, Clermont University, 63003 Clermont-Ferrand cedex 1, France
| | - Cyrus Moini
- Department of Cardiology, GHSIF-Melun, 77000 Melun, France
| | - Nicolas Lellouche
- Department of Cardiology, University Hospital Henri-Mondor, AP-HP, 94000 Créteil, France.
| | - Grégoire Massoulié
- Cardiology Department, CHU Clermont-Ferrand, Clermont University, 63003 Clermont-Ferrand cedex 1, France
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11
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Landra F, Nesti M, Garibaldi S, Mirizzi G, Startari U, Panchetti L, Piacenti M, Taddeucci S, Formichi BA, Stefani M, Galiberti S, Lionetti V, Solinas P, Levantesi BM, Italia C, Rossi A. A proposed index of myocardial staining for vein of Marshall ethanol infusion: an Italian single-center experience. J Interv Card Electrophysiol 2024:10.1007/s10840-023-01732-4. [PMID: 38206450 DOI: 10.1007/s10840-023-01732-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Mitral isthmus (MI) conduction block is a fundamental step in anatomical approach treatment for persistent atrial fibrillation (PeAF). However, MI block is hardly achievable with endocardial ablation only. Retrograde ethanol infusion (EI) into the vein of Marshall (VOM) facilitates MI block. Fluorographic myocardial staining (MS) during VOM-EI could be helpful in predicting procedural alcoholization outcome even if its role is qualitatively assessed in the routine. The aim was to quantitatively assess MS during VOM-EI and to evaluate its association with MI block achievement. METHODS Consecutive patients undergoing catheter ablation for PeAF at Fondazione Toscana Gabriele Monasterio (Pisa, Italy) from February 2022 to May 2023 were considered. Patients with identifiable VOM were included. A proposed index of MS (MSI) was retrospectively calculated in each included patient. Correlation of MSI with low-voltage zones (LVZ) extension after VOM-EI and its association with MI block achievement were assessed. RESULTS In total, 42 patients out of 49 (85.8%) had an identifiable VOM. MI block was successfully achieved in 35 patients out of 42 (83.3%). MSI was significantly associated with the occurrence of MI block (OR 1.24 (1.03-1.48); p = 0.022). A higher MSI resulted in reduced ablation time (p = 0.014) and reduced radiofrequency applications (p = 0.002) to obtain MI block. MSI was also associated with MI block obtained by endocardial ablation only (OR 1.07 (1.02-1.13); p = 0.002). MSI was highly correlated with newly formed LVZ extension (r = 0.776; p = 0.001). CONCLUSIONS In our study cohort, optimal MSI predicts MI block and facilitates its achievement with endocardial ablation only.
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Affiliation(s)
- Federico Landra
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci 1, Siena, Italy.
| | | | | | | | | | | | | | - Simone Taddeucci
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci 1, Siena, Italy
| | | | | | | | | | | | | | | | - Andrea Rossi
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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12
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Mizuno Y, Kumazawa D, Maeda M, Onodera K, Nomura T, Yamashita K. Optimal treatment of biatrial tachycardia diagnosed by one-chamber mapping within an ultrahigh-resolution mapping system. J Cardiol Cases 2024; 29:19-22. [PMID: 38188324 PMCID: PMC10770096 DOI: 10.1016/j.jccase.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 01/09/2024] Open
Abstract
Biatrial tachycardia (BiAT) is a rare arrhythmia, and identification of the re-entry circuit is often complicated. By creating an activation map of the right atrium, left atrium, and coronary sinus as a single chamber, the LUMIPOINT module of the Rhythmia mapping system (Boston Scientific, Marlborough, MA, USA) can be used in real time to make an accurate diagnosis. Ablation of the Bachmann bundle is a feasible way to terminate BiAT, but might cause interatrial conduction delay and electrical isolation of the left atrial appendage. Chemical ablation into the vein of Marshall might be the more beneficial treatment, avoiding any potential interatrial conduction delay.
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Affiliation(s)
- Yosuke Mizuno
- Heart Rhythm Center, Department of Cardiovascular Medicine, Sendai Kosei Hospital, Sendai-shi, Miyagi, Japan
| | - Daiki Kumazawa
- Heart Rhythm Center, Department of Cardiovascular Medicine, Sendai Kosei Hospital, Sendai-shi, Miyagi, Japan
| | - Manabu Maeda
- Heart Rhythm Center, Department of Cardiovascular Medicine, Sendai Kosei Hospital, Sendai-shi, Miyagi, Japan
| | - Kosuke Onodera
- Heart Rhythm Center, Department of Cardiovascular Medicine, Sendai Kosei Hospital, Sendai-shi, Miyagi, Japan
| | - Takehiro Nomura
- Heart Rhythm Center, Department of Cardiovascular Medicine, Sendai Kosei Hospital, Sendai-shi, Miyagi, Japan
| | - Kennosuke Yamashita
- Heart Rhythm Center, Department of Cardiovascular Medicine, Sendai Kosei Hospital, Sendai-shi, Miyagi, Japan
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13
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Ge W, Li T, Lu Y, Jiang J, Tung T, Yan S. Efficacy and feasibility of vein of Marshall ethanol infusion during persistent atrial fibrillation ablation: A systematic review and meta-analysis. Clin Cardiol 2024; 47:e24178. [PMID: 37933170 PMCID: PMC10766122 DOI: 10.1002/clc.24178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/30/2023] [Accepted: 10/16/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Catheter ablation (CA) is currently used to treat persistent atrial fibrillation (PeAF). However, its effectiveness is limited. This study aimed to estimate the effectiveness of the vein of Marshall absolute ethanol injection (VOM-EI) for PeAF ablation. HYPOTHESIS Adjunctive vein of Marshall ethanol injection (VOM-EI) strategies are more effective than conventional catheter ablation (CA) and have similar safety outcomes. METHODS We extensively searched the literature for studies evaluating the effectiveness and safety of VOM-EI + CA compared with CA alone. The primary endpoint was the rate of acute bidirectional block of the isthmus of the mitral annulus (MIBB). The secondary endpoints were atrial fibrillation (AF) or atrial tachycardia (AT) recurrence over 30 seconds after a 3-month blanking period. Weighted pooled risk ratios (RRs) and corresponding 95% confidence intervals (CIs) were calculated using a random effects model. RESULTS Based on the selection criteria, nine studies were included in this systematic review, including patients with AF (n = 2508), persistent AF (n = 1829), perimitral flutter (n = 103), and perimitral AT (n = 165). There were 1028 patients in the VOM-EI + CA group and 1605 in the CA alone group. The VOM-EI + CA group showed a lower rate of AF/AT relapse (RR = 0.70; 95% CI = 0.53-0.91; p = .008) and a higher rate of acute MIBB (RR = 1.29; 95% CI = 1.11-1.50; p = .0007) than the CA alone group. CONCLUSION Our meta-analysis revealed that adjunctive VOM-EI strategies are more effective than conventional CA and have similar safety outcomes.
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Affiliation(s)
- Wei‐Li Ge
- Department of CardiologyShandong Provincial Qianfoshan HospitalShandong UniversityJinanShandongChina
- Department of CardiologyTaizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical UniversityZhejiangChina
| | - Tao Li
- Department of CardiologyTaizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical UniversityZhejiangChina
| | - Yi‐Fei Lu
- Department of CardiologyTaizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical UniversityZhejiangChina
| | - Jian‐Jun Jiang
- Department of CardiologyTaizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical UniversityZhejiangChina
| | - Tao‐Hsin Tung
- Evidence‐Based Medicine Center, Taizhou Hospital of Zhejiang ProvinceWenzhou Medical UniversityLinhaiChina
- Department of UrologyTaizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Enze Hospital, Taizhou Enze Medical Center (Group), Affilitated to Hangzhou Medical CollegeTaizhouZhejiangChina
- Key Laboratory of Evidence‐Based Radiology of TaizhouLinhaiZhejiangChina
| | - Su‐Hua Yan
- Department of CardiologyShandong Provincial Qianfoshan HospitalShandong UniversityJinanShandongChina
- Department of CardiologyShandong Provincial Qianfoshan HospitalJinanChina
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14
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Ishimura M, Yamamoto M, Himi T, Kobayashi Y. Comparison of the effect of ethanol infusion into the vein of Marshall between with and without collateral veins. J Cardiovasc Electrophysiol 2024; 35:25-34. [PMID: 37890043 DOI: 10.1111/jce.16115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/30/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Despite the potential benefits of ethanol infusion into the vein of Marshall (EIVOM) for atrial fibrillation (AF) ablation, concerns about its reversible and unpredictable effects persist. OBJECTIVE To assess the effectiveness of EIVOM in the vein of Marshall (VOM) with collateral veins (CVs) during mitral isthmus and AF ablation. METHODS We included 142 AF patients. EIVOM was performed before radiofrequency ablation, and low-voltage areas (<0.5 mV) were measured before, immediately after, and 1 h after EIVOM. RESULTS Among the 142 patients, 93 (65%) underwent EIVOM, and among these, 35 (37%) were found to have CVs. In the VOM with CVs group, areas with low voltage measured 0 (0-1.85) cm2 before EIVOM, 6.9 (4.1-11.2) cm2 immediately after EIVOM, and 5.7 (3.5-10.6) cm2 1 h after EIVOM. Conversely, in the group designated as VOM without CVs-from which the nine leakage cases were excluded-the areas measured 0 (0-1.35) cm2 , 5.5 (2.6-11.8) cm2 , and 4.7 (1.8-13.5) cm2 at the respective time points. MI line block was fully achieved in 89% (31/35) of cases in the VOM with CVs group and 88% (44/49) in the VOM without CVs groups (p = .94). There was no significant difference in the outcome of AF ablation between these groups (log-rank p = .73). Additionally, no significant difference was observed between EIVOM (+) and EIVOM (-) groups (log-rank p = .59). CONCLUSION EIVOM effectively creates MI line block, and its beneficial effects are sustained for at least 1 h after the procedure despite the low-voltage areas showing a slight reduction in size.
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Affiliation(s)
| | - Masashi Yamamoto
- Department of Cardiology, Kimitsu Central Hospital, Kisarazu, Japan
| | - Toshiharu Himi
- Department of Cardiology, Kimitsu Central Hospital, Kisarazu, Japan
| | - Yoshio Kobayashi
- Department of Cardiology, Chiba University Hospital, Chiba, Japan
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15
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Nesti M, Luca F, Panchetti L, Garibaldi S, Startari U, Mirizzi G, Landra F, Giannoni A, Piacenti M, Rossi A. Impact of Vein of Marshall Ethanol Infusion Combined with Anatomical Ablation for the Treatment of Persistent Atrial Fibrillation: A Long-Term Follow-Up Based on Implantable Loop Recorders. J Clin Med 2023; 12:6916. [PMID: 37959380 PMCID: PMC10648095 DOI: 10.3390/jcm12216916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The best ablation treatment for persistent atrial fibrillation (PeAF) patients is still debated. The vein of Marshall (VOM) seems to be a promising target for ablation and could be combined with a linear set of ablation lesions. The aim of our study is to evaluate the incidence of AF recurrences in a PeAF population treated with a comprehensive ablation approach consisting of VOM ethanol infusion (EI), pulmonary vein isolation (PVI), a left atrial (LA) roofline, a mitral line (guided by the newly formed lesion after alcohol infusion into the VOM and validated by pacing), and a cavotricuspid isthmus line. METHODS Consecutive patients undergoing the first ablation procedure of catheter ablation (CA) for PeAF were enrolled. All patients underwent VOM-EI, PVI, and ablation lines along the roof of the LA, mitral, and cavotricuspid isthmus. LA voltage mapping before and after VOM-EI was also performed. An implantable loop recorder (ILR) was implanted at the end of the ablation in each patient. RESULTS Thirty-one consecutive patients (66 ± 8 years and 71% male) affected by PeAF were included in this study. The VOM-EI procedural phase lasted 21.4 ± 10.1 min. PV isolation and lines were validated in all subjects. The ML block was achieved within 10.8 ± 8.7 min. At a mean follow-up of 12 ± 7 months, 27 out of 31 (87%) patients remained free from AT/AF recurrences. Among the patients with recurrences, two (50%) had incomplete ablation lesions and three (75%) had "suboptimal" VOM-EI. In 23/31 patients (74%), antiarrhythmic drugs (AADs) were discontinued after 1 month of follow-up. No significant complications were reported during the follow-up. CONCLUSIONS this single-center experience demonstrates that VOM-EI systematically combined with an anatomical ablation set in patients with PeAF resulted in feasible, safe, and effective freedom from AF/AT recurrences in 87% of the population after a 1-year follow-up period according to an ILR.
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Affiliation(s)
- Martina Nesti
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (M.N.); (S.G.); (U.S.); (G.M.); (A.G.); (A.R.)
| | - Fabiana Luca
- Cardiology Department, Grande Ospedale Metropolitano, 89124 Reggio Calabria, Italy
| | - Luca Panchetti
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (M.N.); (S.G.); (U.S.); (G.M.); (A.G.); (A.R.)
| | - Silvia Garibaldi
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (M.N.); (S.G.); (U.S.); (G.M.); (A.G.); (A.R.)
| | - Umberto Startari
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (M.N.); (S.G.); (U.S.); (G.M.); (A.G.); (A.R.)
| | - Gianluca Mirizzi
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (M.N.); (S.G.); (U.S.); (G.M.); (A.G.); (A.R.)
| | - Federico Landra
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy;
| | - Alberto Giannoni
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (M.N.); (S.G.); (U.S.); (G.M.); (A.G.); (A.R.)
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Marcello Piacenti
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (M.N.); (S.G.); (U.S.); (G.M.); (A.G.); (A.R.)
| | - Andrea Rossi
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (M.N.); (S.G.); (U.S.); (G.M.); (A.G.); (A.R.)
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Tonko JB, Silberbauer J, Mann I. How to ablate the septo-pulmonary bundle: a case-based review of percutaneous ablation strategies to achieve roof line block. Europace 2023; 25:euad283. [PMID: 37713215 PMCID: PMC10558061 DOI: 10.1093/europace/euad283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023] Open
Abstract
Electrical conduction through cardiac muscle fibres separated from the main myocardial wall by layers of interposed adipose tissue are notoriously difficult to target by endocardial ablation alone. They are a recognised important cause for procedural failure due to the difficulties of delivering sufficient energy via the endocardial radiofrequency catheter to reach the outer epicardial layer without risking adverse events of the otherwise thin walled atria. Left atrial ablations for atrial fibrillation (AF) and tachycardia are commonly affected by the presence of several epicardial structures, with the septo-pulmonary bundle (SPB), Bachmann's bundle, and the ligament of Marshall all posing substantial challenges for endocardial procedures. Delivery of a transmural lesion set is essential for sustained pulmonary vein isolation and for conduction block across linear atrial lines which in turn has been described to translate into a reduced AF/atrial tachycardia recurrence rate. To overcome the limitations of endocardial-only approaches, surgical ablation techniques for epicardial or combined hybrid endo-epicardial ablations have been described to successfully target these connections. Yet, these techniques confer an increase in procedure complexity, duration, cost, and morbidity. Alternatively, coronary venous system ethanol ablation has been successfully employed by sub-selecting the vein of Marshall to facilitate mitral isthmus line block, although this approach is naturally limited to this area by the coronary venous anatomy. Increased awareness of the pathophysiological relevance of these epicardial structures and their intracardiac conduction patterns in the era of high-resolution 3D electro-anatomical mapping technology has allowed greater understanding of their contribution to the persistence of AF as well as failure to achieve transmural block by traditional ablation approaches. This might translate into novel catheter ablation strategies with procedural success rates comparable to surgical 'cut-and-sew' techniques. This review aims to give an overview of percutaneous catheter ablation strategies to target the SPB, an important cause of failed block across the roof line and isolation of the left atrial posterior wall and/or the pulmonary veins. Existing and investigational technologies will be discussed and an outlook of future approaches provided.
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Affiliation(s)
- Johanna Bérénice Tonko
- Institute for Cardiovascular Science, University College London, 5 University Street, WC1E 6JF London, UK
- Department of Cardiology, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Foundation Trust, Eastern Rd, Brighton BN2 5BE, UK
| | - John Silberbauer
- Department of Cardiology, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Foundation Trust, Eastern Rd, Brighton BN2 5BE, UK
| | - Ian Mann
- Department of Cardiology, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Foundation Trust, Eastern Rd, Brighton BN2 5BE, UK
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Cerantola M, Hanumanthu BKJ, Hyman MC. Ablation of perimitral flutter in a patient with a partially inaccessible left atrium. HeartRhythm Case Rep 2023; 9:704-708. [PMID: 38047205 PMCID: PMC10691951 DOI: 10.1016/j.hrcr.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Affiliation(s)
- Maxime Cerantola
- Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Balaram Krishna J. Hanumanthu
- Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew C. Hyman
- Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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18
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Li J, Cui S, Song H, Cui L, Yu H, Chu Y, Dong S. A novel stepwise catheter ablation method of the mitral isthmus for persistent atrial fibrillation: efficacy and reproducibility. BMC Cardiovasc Disord 2023; 23:466. [PMID: 37715135 PMCID: PMC10504774 DOI: 10.1186/s12872-023-03490-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/01/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Ethanol infusion of the vein of Marshall (EI-VOM) has been widely used to facilitate mitral isthmus (MI) ablation. According to the literature, the success rate of achieving a bidirectional conduction block across the MI ranges from 51 to 96%, with no standardized strategy or method available for cardiac electrophysiologists. OBJECTIVES This study aimed to introduce and evaluate a novel ablation method of MI. METHODS Consecutive patients with persistent atrial fibrillation (PeAF) that underwent catheter ablation were included. The MI ablation procedure followed a stepwise approach. In step 1, ethanol infusion of the vein of Marshall (EI-VOM) was performed. In step 2, a "V-shape" endocardial linear ablation connecting the left inferior pulmonary vein (LIPV) to mitral annulus (MA) was performed. In step 3, earliest activation sites(EASs) near the ablation line were identified using activation mapping followed by reinforced ablation. In step 4, precise epicardial ablation was performed, with the catheter introduced into the coronary sinus(CS) to target key ablation targets (KATs). RESULTS 135 patients with PeAF underwent catheter ablation with the stepwise ablation method adopted in 119 cases. Bidirectional conduction blocks were achieved in 117 patients (98.3%). The block rates of every step were 0%, 58.0%, 44.0%, and 92.9%, and the cumulative block rates for the four steps were 0%, 58.0%, 76.5%, and 98.3%, respectively. No patient experienced fatal complications. CONCLUSIONS Our novel stepwise catheter ablation method for MI yielded a high bidirectional block rate with high reproducibility.
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Affiliation(s)
- Jingchao Li
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Shihua Cui
- Dalian Medical University, Dalian, China
| | - Huihui Song
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Luqian Cui
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Haijia Yu
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yingjie Chu
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, China.
| | - Shujuan Dong
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, China.
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19
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Ishimura M, Yamamoto M, Himi T, Kobayashi Y. Efficacy and durability of posterior wall isolation with ethanol infusion into the vein of Marshall. J Cardiovasc Electrophysiol 2023; 34:1630-1639. [PMID: 37337457 DOI: 10.1111/jce.15977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 06/02/2023] [Accepted: 06/11/2023] [Indexed: 06/21/2023]
Abstract
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.
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Affiliation(s)
| | - Masashi Yamamoto
- Department of Cardiology, Kimitsu Central Hospital, Kisarazu, Japan
| | - Toshiharu Himi
- Department of Cardiology, Kimitsu Central Hospital, Kisarazu, Japan
| | - Yoshio Kobayashi
- Department of Cardiology, Chiba University Hospital, Chiba, Japan
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20
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Davong B, Adeliño R, Delasnerie H, Albenque JP, Combes N, Cardin C, Voglimacci-Stephanopoli Q, Combes S, Boveda S. Pulsed-Field Ablation on Mitral Isthmus in Persistent Atrial Fibrillation: Preliminary Data on Efficacy and Safety. JACC Clin Electrophysiol 2023:S2405-500X(23)00261-X. [PMID: 37354173 DOI: 10.1016/j.jacep.2023.03.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Pulsed-field ablation (PFA) is a new and promising modality of ablation that has been shown to specifically ablate cardiac tissue while sparing other anatomic structures, thus avoiding thermal ablation-related complications. Recent studies have certified safety and efficacy of PFA for pulmonary vein isolation (PVI) in the setting of paroxysmal atrial fibrillation (AF). However, there are very limited data assessing the feasibility and safety of PFA ablation of different substrates within the left atrium in the setting of persistent AF. OBJECTIVES The purpose of this study was to evaluate the feasibility and safety of mitral isthmus (MI) ablation in addition to PVI and posterior wall (PW) ablation with PFA in patients with persistent AF. METHODS We prospectively included all consecutive patients with persistent AF who underwent a first ablation procedure with PFA. We performed in all these patients a substrate ablation strategy comprising PVI, PW, and MI ablation with the use of PFA only. The primary feasibility endpoint was obtaining a persistent MI block at the end of the procedure. The safety endpoint was a composite of major safety events. RESULTS From November 2021 to September 2022, we included 45 patients. Complete MI block was achieved in all 45 (100%). Three patients presented with complications, among them 2 cases (4.4%) of reversible and nonfatal coronary spasm. During a mean follow-up time of 107.8 ± 59.5 days, a 20% recurrence rate was observed. CONCLUSIONS PFA is a feasible and safe ablation approach for mitral isthmus ablation in addition to PVI in patients with persistent AF.
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Affiliation(s)
- Baptiste Davong
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| | - Raquel Adeliño
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| | - Hubert Delasnerie
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| | | | - Nicolas Combes
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| | - Christelle Cardin
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| | | | - Stéphane Combes
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France.
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21
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Takagi T, Derval N, Duchateau J, Chauvel R, Tixier R, Marchand H, Bouyer B, André C, Kamakura T, Krisai P, Ascione C, Balbo C, Cheniti G, Denis A, Sacher F, Hocini M, Jaïs P, Haïssaguerre M, Pambrun T. Gaps after linear ablation of persistent atrial fibrillation (Marshall-PLAN): Clinical implication. Heart Rhythm 2023; 20:14-21. [PMID: 36115541 DOI: 10.1016/j.hrthm.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/30/2022] [Accepted: 09/09/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Beyond pulmonary vein (PV) isolation, anatomic isthmus transection is an adjunctive strategy for persistent atrial fibrillation. Data on the durability of multiple lines of block remain scarce. OBJECTIVE The purpose of this study was to evaluate the impact of gaps within such a lesion set. METHODS We followed 291 consecutive patients who underwent (1) vein of Marshall ethanol infusion, (2) PV isolation, and (3) mitral, cavotricuspid, and dome isthmus transection. Dome transection relied on 2 distinct strategies over time: a single roof line with touch-ups applied in case of gap demonstrated by conventional maneuvers (first leg), and an alternative floor line if the roof line exhibited a gap during high-density mapping with careful electrogram reannotation (second leg). RESULTS Twelve-month sinus rhythm maintenance was 70% after 1 procedure and 94% after 1 or 2 procedures. Event-free survival after the first procedure was lower in case of residual gaps within the lesion set (log-rank, P = .004). Delayed gaps were found in 94% of a second procedure performed in the 69 patients relapsing despite a complete lesion set with PV gaps increasing the risk of recurrence of atrial fibrillation (67% vs 34%; P = .02) and anatomic isthmus gaps supporting a majority of atrial tachycardias (60%). Between the first leg and the second leg, a significant decrease was found in roof lines considered blocked during the first procedure (99% vs 78%; P < .001) and in delayed dome gaps observed during a second procedure (68% vs 43%; P = .05). CONCLUSION Gaps are arrhythmogenic and can be reduced by optimized ablation and assessment of lines of block. Closing these gaps improves sinus rhythm maintenance.
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Affiliation(s)
- Takamitsu Takagi
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France.
| | - Nicolas Derval
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Josselin Duchateau
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Rémi Chauvel
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Romain Tixier
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Hugo Marchand
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Benjamin Bouyer
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Clémentine André
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Tsukasa Kamakura
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Philipp Krisai
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Ciro Ascione
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Conrado Balbo
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Ghassen Cheniti
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Arnaud Denis
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Frédéric Sacher
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Mélèze Hocini
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Pierre Jaïs
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Michel Haïssaguerre
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Thomas Pambrun
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
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22
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O’Neill L, De Becker B, De Smet M, Le Polain De Waroux JB, Tavernier R, Duytschaever M, Knecht S. Atrial tachycardia occurring after a prior atrial fibrillation ablation procedure: Does non-inducibility matter? Front Cardiovasc Med 2022; 9:1073239. [PMID: 36568552 PMCID: PMC9769961 DOI: 10.3389/fcvm.2022.1073239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
Recurrent atrial tachycardia (AT) is a common phenomenon after catheter ablation for AF, particularly in the setting of additional substrate ablation, with many studies demonstrating gap-related macro re-entrant AT (predominantly mitral and roof dependent) to be the dominant mechanism. Although multiple inducible ATs after ablation of the clinical AT are commonly described at repeat procedures, the optimal ablation strategy, and procedural endpoints are unclear in this setting. A recent randomized study addressing the question of non-inducibility as a procedural endpoint demonstrated no additional benefits to the ablation of all induced, non-clinical ATs, but it was limited by small numbers and high rates of non-inducibility. Nevertheless, once ablation of the clinical AT has been successfully performed, ensuring durable linear block and PV isolation may be sufficient for the prevention of further AT. Durable linear block, particularly at the mitral isthmus, is difficult to achieve but may be facilitated by the real-time evaluation of lesion quality and contiguity and the novel technique of vein of Marshall ethanol infusion. Large-scale, randomized trials are needed, nonetheless, to fully assess the optimal ablation strategy in the setting of recurrent AT post-AF ablation.
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23
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Evolving Role of Catheter Ablation for Atrial Fibrillation: Early and Effective Rhythm Control. J Clin Med 2022; 11:jcm11226871. [PMID: 36431348 PMCID: PMC9696051 DOI: 10.3390/jcm11226871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/11/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022] Open
Abstract
Catheter Ablation (CA) is an effective therapeutic option in treating atrial fibrillation (AF). Importantly, recent data show that CA as a rhythm control strategy not only significantly reduces AF burden, but also substantially improves clinical hard endpoints. Since AF is a progressive disease, the time of Diagnosis-to-Intervention appears crucial. Recent evidence shows that earlier rhythm control is associated with a lower risk of adverse cardiovascular outcomes in patients with early AF. Particularly, CA as an initial first line rhythm control strategy is associated with significant reduction of arrhythmia recurrence and rehospitalization in patients with paroxysmal AF. CA is shown to significantly lower the risk of progression from paroxysmal AF to persistent AF. When treating persistent AF, the overall clinical success after ablation remains unsatisfactory, however the ablation outcome in patients with "early" persistent AF appears better than those with "late" persistent AF. "Adjunctive" ablation on top of pulmonary vein isolation (PVI), e.g., ablation of atrial low voltage area, left atrial posterior wall, vein of Marshall, left atrial appendage, etc., may further reduce arrhythmia recurrence in selected patient group. New ablation concepts or new ablation technologies have been developing to optimize therapeutic effects or safety profile and may ultimately improve the clinical outcome.
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24
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Li X, Li M, Zhang Y, Zhang H, Wu W, Ran B, Li X, Tang Q, Fu B. Simplified stepwise anatomical ablation strategy for mitral isthmus: efficacy, efficiency, safety, and outcome. Europace 2022; 25:610-618. [PMID: 36353823 PMCID: PMC9934997 DOI: 10.1093/europace/euac204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/23/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS Bidirectional and durable block of mitral isthmus (MI) is essential for catheter ablation of persistent atrial fibrillation (PeAF) and perimitral flutter (PMF), but it remains a challenge. The aim of this study was to create a simple anatomical ablation strategy with minimal fluoroscopy that would yield a high success rate for MI block. METHODS AND RESULTS Patients with PeAF or PMF were included. Mitral isthmus was ablated in a stepwise strategy. In Step 1, endocardial MI linear ablation was performed; in Step 2, ablation was targeted to the posterolateral portion of the left atrium along the MI line; in Step 3, epicardial ablation within the coronary sinus (CS) was performed across the MI line to the ostium of the vein of Marshall (VOM) or performed within the VOM if available; in Step 4, the catheter was rotated and ablated in the CS to isolate the CS; and in Step 5, the early activation site with complex component potential above the MI line during distal CS pacing was considered as the ablation target. All patients were followed up. A total of 178 (17 patients with mechanical prosthetic mitral valve) were included. One hundred and sixty-six patients achieved a confirmed MI bidirectional conduction block (93%). One patient had cardiac tamponade. Four patients showed re-conduction across the MI line during a repeated ablation. In the latest follow-up [12 (7, 16) months], 161 of 178 (90%) patients maintained their sinus rhythm. CONCLUSION A simple stepwise anatomical ablation strategy for MI shows a high success rate with low fluoroscopy exposure.
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Affiliation(s)
- Xiaoqin Li
- Department of Cardiology, Chongqing General Hospital, University of Chinese Academy of Sciences, 118 Xingguang Road, Yubei District, 401120 Chongqing, China
| | - Mengmeng Li
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Yuan Zhang
- Department of Cardiology, Chongqing General Hospital, University of Chinese Academy of Sciences, 118 Xingguang Road, Yubei District, 401120 Chongqing, China
| | - Hao Zhang
- Department of Cardiology, Chongqing General Hospital, University of Chinese Academy of Sciences, 118 Xingguang Road, Yubei District, 401120 Chongqing, China
| | - Wenli Wu
- Department of Cardiology, Chongqing General Hospital, University of Chinese Academy of Sciences, 118 Xingguang Road, Yubei District, 401120 Chongqing, China
| | - Boli Ran
- Department of Cardiology, Chongqing General Hospital, University of Chinese Academy of Sciences, 118 Xingguang Road, Yubei District, 401120 Chongqing, China
| | - Xiaoli Li
- Department of Cardiology, Chongqing General Hospital, University of Chinese Academy of Sciences, 118 Xingguang Road, Yubei District, 401120 Chongqing, China
| | - Qianmei Tang
- Department of Cardiology, Chongqing General Hospital, University of Chinese Academy of Sciences, 118 Xingguang Road, Yubei District, 401120 Chongqing, China
| | - Biao Fu
- Corresponding author. Tel: +86 2363390551. E-mail address:
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The Maine vein of Marshall ethanol experience: learning curve and safety. J Interv Card Electrophysiol 2022; 66:661-671. [PMID: 36181632 DOI: 10.1007/s10840-022-01378-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/19/2022] [Indexed: 10/06/2022]
Abstract
BACKGROUND The marginal benefit of ethanol infusion into the vein of Marshall (VOM) as an adjunct to atrial fibrillation ablation has shown promise in a single randomized study and case series from very experienced centers. However, adoption has not been widespread and the impact on real-world outcomes outside of leading centers is not established. The objective in this study is to understand the learning curve, and explore procedural outcomes and safety with VOM ethanol infusion from a large single medical center. METHODS One hundred twenty nine atrial ablation cases wherein VOM ethanol infusion was attempted were identified from the time of the program's inception in 2019 at Maine Medical Center (Portland, ME). Our technical approach, procedural success, and complications were adjudicated from the medical record. RESULTS The overall VOM ethanol infusion success was 90%. Infusion success rates improved and fluoroscopy utilization decreased with experience. Arrhythmia recurrence was 14% after a mean follow-up of 9.5 months. Complications occurred in 5.4% of patients, including a 3.1% risk of delayed tamponade. CONCLUSION In our single center experience, VOM ethanol infusion was feasible with a high technical success rate. These positive results are balanced against a concerning rate of delayed tamponade.
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Atypisches Vorhofflattern. Herzschrittmacherther Elektrophysiol 2022; 33:341-350. [PMID: 35986095 PMCID: PMC9411094 DOI: 10.1007/s00399-022-00887-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/02/2022]
Abstract
ZusammenfassungIm Gegensatz zum typischen Vorhofflattern handelt es sich beim atypischen Vorhofflattern um eine heterogene Gruppe von rechts- und linksatrialen Makro- bzw. Localized-Reentry-Tachykardien, deren kritischer Bestandteil zur Aufrechterhaltung der Tachykardie nicht der cavotrikuspidale Isthmus ist. Atypisches Vorhofflattern tritt gehäuft nach vorangegangener Katheterablation sowie nach herzchirurgischen Eingriffen auf. Die intraprozedurale Erfolgsrate während der Ablation ist hoch, wobei die Rezidivrate von strukturellen Veränderungen der Vorhöfe sowie des zugrundeliegenden Mechanismus abhängig ist. Dieser Artikel bietet einen Überblick über die Mechanismen sowie über Mapping- und Ablationsstrategien der häufigsten Formen von rechts- und linksatrialem atypischem Vorhofflattern. Dieser Beitrag ist Teil der Serie „EP-Basics“ zur gezielten Fortbildung im Bereich Invasive Elektrophysiologie. Grundlagen, Klinik und Therapie des atypischen Vorhofflatterns werden mit Fokus auf klinisch relevante Aspekte dargelegt. Vorgehensweise und Befunde der invasiven elektrophysiologischen Diagnostik und die Ablationsbehandlung bilden den Schwerpunkt dieses Artikels.
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He B, Zhao F, Yu W, Li Y, Wu X, Lu Z. Ethanol Infusion of Vein of Marshall for the Treatment of Persistent Atrial Fibrillation: The Basics and Clinical Practice. J Cardiovasc Dev Dis 2022; 9:jcdd9080270. [PMID: 36005434 PMCID: PMC9409861 DOI: 10.3390/jcdd9080270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/21/2022] Open
Abstract
Catheter ablation for persistent atrial fibrillation (PeAF) is particularly challenging, as the clinical outcomes are modest. Pulmonary vein isolation (PVI) plus linear ablation is one of the main strategies for PeAF ablation. Completely durable transmural lesions are difficult to achieve by catheter ablation during mitral isthmus ablation. The ligament of Marshall contains the vein of Marshall (VOM), myocardial tracts and innervation, and serves as arrhythmogenic foci that make it an attractive target in catheter ablation of atrial fibrillation. Additionally, it co-localizes with the mitral isthmus, and may serve as a part of the perimitral isthmus reentrant circuit. Ethanol infusion into the VOM results in rapid ablation of the neighboring myocardium and its innervation. Its incorporation into PVI significantly increases the success rate of mitral isthmus block and the clinical outcome of PeAF ablation.
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Affiliation(s)
- Bo He
- Department of Cardiology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan 430071, China
| | - Fang Zhao
- Department of Cardiology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan 430071, China
| | - Wenxi Yu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan 430071, China
| | - Yi Li
- Department of Cardiology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan 430071, China
| | - Xiaoyan Wu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan 430071, China
| | - Zhibing Lu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan 430071, China
- Correspondence: ; Tel.: +86-27-67813073
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Kamakura T, André C, Duchateau J, Nakashima T, Nakatani Y, Takagi T, Krisai P, Ascione C, Balbo C, Tixier R, Chauvel R, Cheniti G, Kusano K, Cochet H, Denis A, Sacher F, Hocini M, Jaïs P, Haïssaguerre M, Derval N, Pambrun T. Distribution of atrial low voltage induced by vein of Marshall ethanol infusion. J Cardiovasc Electrophysiol 2022; 33:1687-1693. [PMID: 35637606 DOI: 10.1111/jce.15573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/18/2022] [Accepted: 04/09/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Systematic and quantitative descriptions of vein of Marshall (VOM)-induced tissue ablation are lacking. We sought to characterize the distribution of low voltage observed in the left atrium (LA) after VOM ethanol infusion. METHODS AND RESULTS The distribution of ethanol-induced low voltage was evaluated by comparing high-density maps performed before and after VOM ethanol infusion in 114 patients referred for atrial fibrillation ablation. The two most frequently impacted segments were the inferior portion of the ridge (82.5%) and the first half of the mitral isthmus (pulmonary vein side) (92.1%). Low-voltage absence in these typical areas resulted from inadvertent ethanol infusion in the left atrial appendage vein (n = 3), initial VOM dissection (n = 3), or a "no branches" VOM morphology (n = 1). Visible anastomosis of the VOM with roof or posterior veins more frequently resulted in low-voltage extension beyond typical areas, toward the entire left antrum (19.0% vs. 1.9%, p = .0045) or the posterior LA (39.7% vs. 3.8%, p < .001) but with a limited positive predictive value ranging from 29.4% to 43.5%. Ethanol-induced low voltage covered a median LA surface of 3.6% (1.9%-5.0%) and did not exceed 8% of the LA surface in 90% of patients. CONCLUSION VOM ethanol infusion typically locates at the inferior ridge and the adjacent half of the mitral isthmus. Low-voltage extensions can be anticipated but not guaranteed by the presence of visible anastomosis of the VOM with roof or posterior veins.
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Affiliation(s)
- Tsukasa Kamakura
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France.,Department of Cardiovascular Medicine, Division of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Clémentine André
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Takashi Nakashima
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Yosuke Nakatani
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Takamitsu Takagi
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Philipp Krisai
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Ciro Ascione
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Conrado Balbo
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Romain Tixier
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Rémi Chauvel
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Ghassen Cheniti
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Kengo Kusano
- Department of Cardiovascular Medicine, Division of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hubert Cochet
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Arnaud Denis
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Frédéric Sacher
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Mélèze Hocini
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Pierre Jaïs
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Michel Haïssaguerre
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France
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Li F, Sun JY, Wu LD, Zhang L, Qu Q, Wang C, Qian LL, Wang RX. The Long-Term Outcomes of Ablation With Vein of Marshall Ethanol Infusion vs. Ablation Alone in Patients With Atrial Fibrillation: A Meta-Analysis. Front Cardiovasc Med 2022; 9:871654. [PMID: 35571170 PMCID: PMC9098965 DOI: 10.3389/fcvm.2022.871654] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/29/2022] [Indexed: 01/22/2023] Open
Abstract
Background The long-term outcomes of ablation with vein of Marshall ethanol infusion (VOM-ABL) compared with ablation alone in patients with atrial fibrillation (AF) remains elusive. We aimed to explore whether VOM-ABL showed better long-term benefits and screen the potential determinants of outcome impact of VOM-ABL procedure. Methods PubMed, Cochrane Library, Web of Science, and Embase were searched up to 1st September 2021. Studies comparing the long-term (one-year or longer) outcomes between VOM-ABL and ablation alone were included. Subgroup analysis identified potential determinants for VOM-ABL procedure. Results Compared with ablation alone, VOM-ABL was associated with a significantly higher rate of long-term freedom from AF/AT (risk ratio [RR], 1.28; 95% confidence interval [CI], 1.12–1.47; p = 0.00) and successful mitral isthmus (MI) block (RR, 1.52; 95% CI, 1.16–1.99; p = 0.00), whereas, there was no significant difference in pericardial effusion, stroke/transient ischemic attack (TIA), and all-cause death. Subgroup analysis identified two significant treatment-covariate interactions: one was ablation strategy subgroup (pulmonary vein isolation plus linear and/or substrate ablation [PVI+]; RR, 1.41; 95% CI, 1.27–1.56 vs. PVI; RR, 1.05; 95% CI, 0.92–1.19, p = 0.00 for interaction) for freedom from AF/AT, while the other was VOM-ABL group sample size subgroup (≥ 100; RR, 1.98; 95% CI, 1.24–3.17 vs. <100; RR, 1.20; 95% CI, 1.10–1.30, p = 0.04 for interaction) for MI block. Conclusions This meta-analysis demonstrates that VOM-ABL has superior efficacy and comparable safety over ablation alone in AF patients with long-term follow-up. Moreover, PVI+ and VOM-ABL group sample size ≥ 100 may be associated with a great impact on freedom from AF/AT and MI block, respectively.
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Affiliation(s)
- Feng Li
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Jin-Yu Sun
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Li-Da Wu
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Lei Zhang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Qiang Qu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chao Wang
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ling-Ling Qian
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Ru-Xing Wang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
- *Correspondence: Ru-Xing Wang
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Nakashima T, Pambrun T, Vlachos K, Goujeau C, André C, Krisai P, Daniel Ramirez F, Pintican G, Kamakura T, Takagi T, Nakatani Y, Surget E, Cheniti G, Tixier R, Chauvel R, Duchateau J, Sacher F, Cochet H, Hocini M, Haïssaguerre M, Jaïs P, Derval N. Strategy for Repeat Procedures in Patients with Persistent Atrial Fibrillation: Systematic Linear Ablation with Adjunctive Ethanol Infusion into the Vein of Marshall versus Electrophysiology‐Guided Ablation. J Cardiovasc Electrophysiol 2022; 33:1116-1124. [DOI: 10.1111/jce.15472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/22/2022] [Accepted: 02/28/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | | | | | - F. Daniel Ramirez
- CHU Bordeaux, IHU Lyric, Univ. BordeauxFrance
- Division of Cardiology, University of Ottawa Heart InstituteOttawaOntarioCanada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Pierre Jaïs
- CHU Bordeaux, IHU Lyric, Univ. BordeauxFrance
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Janga C, Madhavan M, Siontis KC, Killu AM. Vein of Marshall Alcohol Ablation for Dormant Pulmonary Vein Conduction: A Case Report. J Cardiovasc Electrophysiol 2022; 33:1070-1071. [PMID: 35332624 DOI: 10.1111/jce.15466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/25/2022] [Accepted: 03/16/2022] [Indexed: 11/30/2022]
Abstract
We report a case of alcohol ablation into a Vein of Marshall for recurrent dormant conduction into the pulmonary veins with adenosine testing in a patient where 2 prior ablation attempts failed to isolate the left vein. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Chaitra Janga
- Mayo Clinic, Department of Cardiovascular Medicine, Heart Rhythm Services, 200 First St SW, Rochester, MN, 55905
| | - Malini Madhavan
- Mayo Clinic, Department of Cardiovascular Medicine, Heart Rhythm Services, 200 First St SW, Rochester, MN, 55905
| | - Konstantinos C Siontis
- Mayo Clinic, Department of Cardiovascular Medicine, Heart Rhythm Services, 200 First St SW, Rochester, MN, 55905
| | - Ammar M Killu
- Mayo Clinic, Department of Cardiovascular Medicine, Heart Rhythm Services, 200 First St SW, Rochester, MN, 55905
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Gillis K, O'Neill L, Wielandts JY, Hilfiker G, Almorad A, Lycke M, El Haddad M, le Polain de Waroux JB, Tavernier R, Duytschaever M, Knecht S. Vein of Marshall Ethanol Infusion as First Step for Mitral Isthmus Linear Ablation. JACC Clin Electrophysiol 2022; 8:367-376. [PMID: 35331432 DOI: 10.1016/j.jacep.2021.11.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES In this study, the authors sought to investigate the added value of vein of Marshall ethanol infusion (VOMEt) as first step in facilitating radiofrequency (RF)-guided mitral isthmus (MI) block. BACKGROUND Achieving MI block with the use of RF ablation is challenging. METHODS Seventy patients planned for MI ablation were randomized 1:1 to VOMEt as a first step preceding RF (endocardial and epicardial, VOMFIRST group) vs RF ablation as a first step preceding VOMEt (RFFIRST group). The study end point was incidence of MI block after RF ablation and after the 2 steps. RESULTS In VOMFIRST, VOMEt was successful in 30/35 patients (86%) resulting in a low-voltage area of 12 ± 7.4 cm2 and MI block in 2/35 patients (6%). VOMFIRST, compared with RFFIRST, was associated with higher incidence of MI block after endocardial (46% vs 11%; P < 0.001) and epicardial ablation (94% vs 43%; P < 0.001), with fewer endocardial applications (4 vs 11 vs 4; P < 0.001) and similar epicardial applications (7 vs 8; P = 0.68). Incidence of MI block after the 2 steps was 94% vs 63% (P = 0.001) in VOMFIRST vs RFFIRST, respectively. Additional touch-up RF ablation in both groups resulted in final MI block in all but 1 patient (99%). CONCLUSIONS VOMEt as a first step in RF-guided MI line ablation significantly reduced the number of RF applications needed to achieve MI block, even if the sequence of the ablation steps did not affect the final incidence of block. (Evaluation of Vein of Marshall Ethanol Infusion During Left Atrial Linear Ablation in Patients With Persistent Atrial Fibrillation [MARSHALINE]; NCT04124328).
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Affiliation(s)
- Kris Gillis
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium.
| | - Louisa O'Neill
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | | | - Gabriela Hilfiker
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | - Alexandre Almorad
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | - Michelle Lycke
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | - Milad El Haddad
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | | | - Rene Tavernier
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
| | | | - Sebastien Knecht
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
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Takagi T, Derval N, Pambrun T, Nakatani Y, André C, Ramirez FD, Nakashima T, Krisai P, Kamakura T, Pineau X, Tixier R, Chauvel R, Cheniti G, Duchateau J, Sacher F, Hocini M, Haïssaguerre M, Jaïs P, Cochet H. Optimized Computed Tomography Acquisition Protocol for Ethanol Infusion Into the Vein of Marshall. JACC Clin Electrophysiol 2022; 8:168-178. [PMID: 35210073 DOI: 10.1016/j.jacep.2021.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/03/2021] [Accepted: 09/29/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVES This study sought to introduce a computed tomography (CT) protocol for optimal planning of vein of Marshall (VOM) catheterization. BACKGROUND Ethanol infusion into the VOM (Et-VOM) is increasingly used in atrial fibrillation ablation. METHODS Preprocedural CT was performed with either a conventional (conv-CT; n = 132) or an optimized CT protocol (VOM-CT; n = 126) designed for obtaining on a single image both left atrial and coronary sinus (CS) enhancement. The detection rate and anatomical features of the CT-derived VOM were analyzed and the utility of VOM-CT protocol was assessed by comparing the procedural data. RESULTS VOM was detected in 35% in conv-CT versus 63% in VOM-CT (P < 0.001). The VOM-CT protocol did not impair the assessment of left atrial anatomy and appendage patency. In VOM-CT, the detection of the VOM was related to body mass index and width of epicardial space on posterior wall. Mean distance between CS ostium and VOM was 36 ± 7 mm. Mean VOM diameter was 1.6 ± 0.3 mm. On the CS circumference, the VOM emerged superiorly in 68% and postero-superiorly in 32%. Ethanol infusion into the VOM was attempted in 165 patients (77 conv-CT, 70 VOM-CT, and 18 without-CT). After registration in CARTO, the VOM segmented on CT matched its location on venography in all cases. As compared with conv-CT and without-CT, procedures guided by VOM-CT showed significantly shorter radiation time, shorter procedure time, lower amount of the contrast medium, and fewer contrast injections to obtain VOM catheterization. CONCLUSIONS The proposed CT protocol allows for improved visualization of the VOM, translating into easier VOM catheterization.
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Affiliation(s)
- Takamitsu Takagi
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France.
| | - Nicolas Derval
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Yosuke Nakatani
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Clémentine André
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - F Daniel Ramirez
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Takashi Nakashima
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Philipp Krisai
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Tsukasa Kamakura
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Xavier Pineau
- Département de Cardiovascular Imaging, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | - Romain Tixier
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Remi Chauvel
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Ghassen Cheniti
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Josselin Duchateau
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Frédéric Sacher
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Michel Haïssaguerre
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Pierre Jaïs
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
| | - Hubert Cochet
- Département de Rythmologie, Centre Hospitalier Universitaire Bordeaux, Institut Hospitalo Universitaire L'Institut de RYthmologie et Modélisation Cardiaque (ANR-10-IAHU-04), University of Bordeaux, Bordeaux, France
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Suzuki N, Kaneko S, Fujita M, Shinoda M, Kubota R, Ohashi T, Tatami Y, Suzuki J, Hori H, Adachi K, Ito R, Shirai Y, Yanagisawa S, Inden Y, Murohara T. Comparison of the empirical linear ablation and low voltage area-guided ablation in addition to pulmonary vein isolation in patients with persistent atrial fibrillation: a propensity score-matched analysis. BMC Cardiovasc Disord 2022; 22:13. [PMID: 35065605 PMCID: PMC8783511 DOI: 10.1186/s12872-022-02460-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/11/2022] [Indexed: 11/15/2022] Open
Abstract
Background The efficacy of pulmonary vein isolation (PVI) alone is not guaranteed for persistent atrial fibrillation (PeAF), and it is unclear which type of ablation approach should be applied in addition to PVI. This study aimed to compare outcomes and prognosis between empirical linear ablation and low-voltage area (LVA) ablation after PVI for PeAF. Methods We enrolled 128 patients with PeAF who were assigned to the linear ablation group (n = 64) and the LVA ablation group (n = 64) using a propensity score-matched model. After PVI and cardioversion, the patients underwent either empirical linear ablation or LVA ablation during sinus rhythm. All patients in the linear ablation group underwent both roof line and mitral valve isthmus (MVI) ablations. An electrical-guided ablation targeting LVA (< 0.5 mV) was performed in the LVA group. When there was no LVA in the LVA group, only PVI was applied. We compared the procedural outcomes and recurrence after ablation between the two groups. Results The baseline characteristics were well-balanced between the two groups. Fifty patients had LVA (22 and 28 patients in the linear and LVA groups). The roof and MVI lines were completed in 100% and 96.9% of the patients. During the mean follow-up of 279.5 ± 161.3 days, the LVA group had significantly lower recurrence than the linear group (15 patients [23%] vs. 29 patients [45%], p = 0.014). Thirty-five patients were prescribed antiarrhythmic drugs during the follow-up period (linear group, n = 17; LVA group, n = 18); amiodarone and bepridil were administered to most of the patients (15 and 17 patients, respectively). The difference in the prognosis was relevant among the patients with LVA, while this trend was not observed in those without LVA. The LVA ablation group demonstrated significantly lower radiofrequency energy and shorter procedural time compared to the linear ablation group. The recurrence of atrial flutter was more likely to occur in the linear group than in the LVA group (14 [22%] vs. 6 [9.4%], p = 0.052). Conclusion The electrophysiological-guided LVA ablation is more effective than empirical linear ablation in PeAF patients with LVA. Unnecessary empirical linear ablation might have a risk of iatrogenic gap and atrial flutter recurrence. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02460-9.
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Mhanna M, Beran A, Al-Abdouh A, Sajdeya O, Altujjar M, Alom M, M Abumoawad A, M Elzanaty A, Chacko P, A Eltahawy E. Adjunctive Vein of Marshall Ethanol Infusion During Atrial Fibrillation Ablation: A Systematic Review and Meta-Analysis. J Atr Fibrillation 2021; 14:20200492. [PMID: 34950366 DOI: 10.4022/jafib.20200492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/27/2021] [Accepted: 06/26/2021] [Indexed: 11/10/2022]
Abstract
Introduction Catheter ablation (CA) for atrial fibrillation (AF) can be associated with limited efficacy. Due to its autonomic innervation, the vein of Marshall (VOM) is an attractive target during AF ablation. In this meta-analysis, we aimed to evaluate the efficacy and safety of adjunctive ethanol infusion of VOM (VOM-EI) in AF ablation. Methods We performed a comprehensive literature search for studies that evaluated the efficacy and safety of VOM-EI in AF ablation compared to AF catheter ablation alone. The primary outcome of interest was late (≥3 months) AF or atrial tachycardia (AT) recurrence. The secondary outcomes included acute mitral isthmus bidirectional block (MIBB) and procedural complications (pericardial effusion, stroke, or atrio-esophageal fistula). Pooled relative risk (RR) and corresponding 95% confidence intervals (CIs) were calculated using the random-effects model. Results A total of four studies, including 804 AF patients (68.2% with persistent AF, the mean age of 63.5±9.9 years, 401 patients underwent VOM-EI plus CA vs. 403 patients who had CA alone), were included in the final analysis. VOM-EI group was associated with a lower risk of late AF/AT recurrence (RR:0.63; 95% CI:0.46-0.87; P = 0.005), and increased probability to achieve acute MIBB (RR:1.39; 95% CI:1.08-1.79; P = 0.009) without an increase in procedural complications (RR:1.05; 95% CI:0.57-1.94; P = 0.87). Conclusions Our meta-analysis demonstrated that adjunctive VOM-EI strategy is more effective than conventional catheter ablation with similar safety profiles.
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Affiliation(s)
- Mohammed Mhanna
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA
| | - Azizullah Beran
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA
| | - Ahmad Al-Abdouh
- Department of Internal Medicine, Saint Agnes Hospital, Baltimore, MD, USA
| | - Omar Sajdeya
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA
| | - Mohammed Altujjar
- Department of Internal Medicine, Promedica Toledo hospital, Toledo, OH, USA
| | - Modar Alom
- Department of Internal Medicine, Promedica Toledo hospital, Toledo, OH, USA
| | - Abdelrhman M Abumoawad
- Department of Internal Medicine, University of Missouri Kansas City, Kansas City, MO, USA
| | - Ahmed M Elzanaty
- Department of Cardiovascular Medicine, The University of Toledo, Toledo, OH, USA
| | - Paul Chacko
- Department of Cardiovascular Medicine, The University of Toledo, Toledo, OH, USA
| | - Ehab A Eltahawy
- Department of Cardiovascular Medicine, The University of Toledo, Toledo, OH, USA
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O’Neill L, Wielandts JY, Gillis K, Hilfiker G, Le Polain De Waroux JB, Tavernier R, Duytschaever M, Knecht S. Catheter Ablation in Persistent AF, the Evolution towards a More Pragmatic Strategy. J Clin Med 2021; 10:jcm10184060. [PMID: 34575173 PMCID: PMC8467025 DOI: 10.3390/jcm10184060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/27/2021] [Accepted: 09/04/2021] [Indexed: 11/16/2022] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide and represents a heterogeneous disorder with a complex pathological basis. While significant technological advances have taken place over the last decade in the field of catheter ablation of AF, response to ablation varies and long-term success rates in those with persistent AF remain modest. Mechanistic studies have highlighted potentially different sustaining factors for AF in the persistent AF population with substrate-driven focal and re-entrant sources in the body of the atria identified on invasive and non-invasive mapping studies. Translation to clinical practice, however, remains challenging and the application of such mapping techniques to clinical ablation has yet to demonstrate a significant benefit beyond pulmonary vein isolation (PVI) alone in the persistent AF cohort. Recent advances in catheter and ablation technology have centered on improving the durability of ablation lesions at index procedure and although encouraging results have been demonstrated with early studies, large-scale trials are awaited. Further meaningful improvement in clinical outcomes in the persistent AF population requires ongoing advancement in the understanding of AF mechanisms, coupled with continuing progress in catheter technology capable of delivering durable transmural lesions.
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Laredo M, Ferchaud V, Thomas O, Moubarak G, Cauchemez B, Zhao A. Durability of Left Atrial Lesions After Ethanol Infusion in the Vein of Marshall. JACC Clin Electrophysiol 2021; 8:41-48. [PMID: 34454885 DOI: 10.1016/j.jacep.2021.06.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to assess the persistence of left atrial (LA) lesions created by ethanol infusion in the vein of Marshall (EIVM) by electroanatomical mapping on repeat catheter ablation for recurrent atrial tachyarrhythmia. BACKGROUND Little is known about the durability of LA lesions created by EIVM. METHODS The study included consecutive patients who underwent EIVM for persistent atrial fibrillation or perimitral LA flutter (index procedure) and repeat catheter ablation for recurrent atrial tachyarrhythmia or atrial fibrillation at a single center between January 2019 and April 2020. The acute effect of EIVM was assessed at the index procedure by comparing the area of bipolar voltage <0.05 mV in the vein of Marshall (VOM) region before and immediately after EIVM. The long-term effect of EIVM was assessed by comparing this area in the VOM region between the redo procedure and the index procedure. RESULTS Twenty-four consecutive patients (mean age 68.6 ± 6.1 years, 58% men) underwent redo procedures after previous EIVM for persistent atrial fibrillation (n = 21 [88%]) or perimitral LA flutter (n = 5 [21%]). In each patient, the EIVM-related lesion persisted, with a chronic scar in the VOM region (median 13.1 cm2 [interquartile range: 8.1-15.9 cm2] vs 12.4 cm2 [interquartile range: 7.6-15.7 cm2] acutely, respectively). One quarter of patients (9 of 20) had late mitral isthmus reconnection, which was located at the mitral annular edge or in the coronary sinus. CONCLUSIONS Atrial lesions created by EIVM are durable, which reinforces the efficacy profile of EIVM. Reconduction sites in the mitral isthmus are located at the edge of the scar and in the coronary sinus.
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Affiliation(s)
- Mikael Laredo
- Laboratoire d'Electrophysiologie, Clinique Ambroise Paré, Neuilly-sur-Seine, France; Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Unité de Rythmologie, Institut de Cardiologie, Paris, France
| | - Virginie Ferchaud
- Centre d'Explorations de Réanimation et d'Intervention Cardiaque, Clinique Ambroise Paré, Neuilly-sur-Seine, France; Service de Cardiologie, CHU Caen Normandie, Caen, France
| | - Olivier Thomas
- Laboratoire d'Electrophysiologie, Clinique Ambroise Paré, Neuilly-sur-Seine, France; Centre d'Explorations de Réanimation et d'Intervention Cardiaque, Clinique Ambroise Paré, Neuilly-sur-Seine, France
| | - Ghassan Moubarak
- Laboratoire d'Electrophysiologie, Clinique Ambroise Paré, Neuilly-sur-Seine, France; Centre d'Explorations de Réanimation et d'Intervention Cardiaque, Clinique Ambroise Paré, Neuilly-sur-Seine, France
| | - Bruno Cauchemez
- Laboratoire d'Electrophysiologie, Clinique Ambroise Paré, Neuilly-sur-Seine, France; Centre d'Explorations de Réanimation et d'Intervention Cardiaque, Clinique Ambroise Paré, Neuilly-sur-Seine, France
| | - Alexandre Zhao
- Laboratoire d'Electrophysiologie, Clinique Ambroise Paré, Neuilly-sur-Seine, France; Centre d'Explorations de Réanimation et d'Intervention Cardiaque, Clinique Ambroise Paré, Neuilly-sur-Seine, France.
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Nakatani Y, Nakashima T, Duchateau J, Vlachos K, Krisai P, Takagi T, Kamakura T, André C, Goujeau C, Daniel Ramirez F, Chauvel R, Tixier R, Takigawa M, Kitamura T, Cheniti G, Denis A, Sacher F, Hocini M, Haïssaguerre M, Jaïs P, Derval N, Pambrun T. Characteristics of macroreentrant atrial tachycardias using an anatomical bypass: Pseudo-focal atrial tachycardia case series. J Cardiovasc Electrophysiol 2021; 32:2451-2461. [PMID: 34314087 DOI: 10.1111/jce.15186] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Human atria comprise distinct layers. One layer can bypass another, and lead to a downstream centrifugal propagation at their interface. We sought to characterize anatomical substrates, electrophysiological properties, and ablation outcomes of "pseudo-focal" atrial tachycardias (ATs), defined as macroreentrant ATs mimicking focal ATs. METHODS AND RESULTS We retrospectively analyzed left atrial ATs showing centrifugal propagation with postpacing intervals (PPIs) after entrainment pacing suggestive of a macroreentrant mechanism. A total of 22 patients had pseudo-focal ATs consisting of 15 perimitral and 7 roof-dependent flutters. A low-voltage area was consistently found at the collision site and colocalized with distinct anatomical structures like the: (1) coronary sinus-great cardiac vein bundle (27%), (2) vein of Marshall bundle (18%), (3) Bachmann bundle (27%), (4) septopulmonary bundle (18%), and (5) fossa ovalis (9%). The mean missing tachycardia cycle length (TCL) was 65 ± 31 ms (22%) on the endocardial activation map. PPI was 0 [0-15] ms and 0 [0-21] ms longer than TCL at the breakthrough site and the opposite site, respectively. While feasible in 21 pseudo-focal ATs (95%), termination was better achieved by blocking the anatomical isthmus than ablating the breakthrough site [20/21 (95%) vs. 1/5 (20%); p < .001]. CONCLUSION Perimitral and roof-dependent flutters with centrifugal propagation are favored by a low-voltage area located at well-identified anatomical structures. Comprehensive entrainment pacing maneuvers are crucial to distinguish pseudo-focal ATs from true focal ATs. Blocking the anatomical isthmus is a better therapeutic option than ablating the breakthrough site.
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Affiliation(s)
- Yosuke Nakatani
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Takashi Nakashima
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Josselin Duchateau
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Konstantinos Vlachos
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Philipp Krisai
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Takamitsu Takagi
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Tsukasa Kamakura
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Clémentine André
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Cyril Goujeau
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - F Daniel Ramirez
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Remi Chauvel
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Romain Tixier
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Masateru Takigawa
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Takeshi Kitamura
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Ghassen Cheniti
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Arnaud Denis
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Frédéric Sacher
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Michel Haïssaguerre
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Pierre Jaïs
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Nicolas Derval
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
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Kamakura T, Derval N, Duchateau J, Denis A, Nakashima T, Takagi T, Ramirez FD, André C, Krisai P, Nakatani Y, Tixier R, Chauvel R, Cheniti G, Kusano K, Cochet H, Sacher F, Hocini M, Jaïs P, Haïssaguerre M, Pambrun T. Vein of Marshall Ethanol Infusion: Feasibility, Pitfalls, and Complications in Over 700 Patients. Circ Arrhythm Electrophysiol 2021; 14:e010001. [PMID: 34280029 PMCID: PMC8376276 DOI: 10.1161/circep.121.010001] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Supplemental Digital Content is available in the text. Vein of Marshall (VOM) ethanol infusion is a relatively new therapeutic option for atrial tachyarrhythmias. We aimed to evaluate the feasibility, pitfalls, and complications associated with this procedure in a large cohort of patients.
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Affiliation(s)
- Tsukasa Kamakura
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.).,Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (T.K., K.K.)
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - Arnaud Denis
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - Takashi Nakashima
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - Takamitsu Takagi
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - F Daniel Ramirez
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - Clémentine André
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - Philipp Krisai
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | | | | | - Rémi Chauvel
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - Ghassen Cheniti
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - Kengo Kusano
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (T.K., K.K.)
| | - Hubert Cochet
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - Frédéric Sacher
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - Mélèze Hocini
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - Pierre Jaïs
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - Michel Haïssaguerre
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, France (T.K., N.D., J.D., A.D., T.N., T.T., F.D.R., C.A., P.K., Y.N., R.T., R.C., G.C., H.C., F.S., M. Hocini, P.J., M. Haïssaguerre, T.P.)
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Kamakura T, Derval N, Duchateau J, Nakashima T, Cochet H, Sacher F, Hocini M, Jais P, Haïssaguerre M, Pambrun T. Incidence of Vein of Marshall Stenosis After Ethanol Infusion: Is Repeated Ethanol Infusion Feasible? JACC Clin Electrophysiol 2021; 7:953-954. [PMID: 34294393 DOI: 10.1016/j.jacep.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/02/2021] [Accepted: 04/04/2021] [Indexed: 10/20/2022]
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Pambrun T, Derval N, Duchateau J, Denis A, Chauvel R, Tixier R, Welte N, André C, Nakashima T, Nakatani Y, Kamakura T, Takagi T, Ramirez FD, Krisai P, Goujeau C, Cheniti G, Vlachos K, Bourier F, Takigawa M, Kitamura T, Frontera A, Sacher F, Hocini M, Haïssaguerre M, Jaïs P. Epicardial course of the musculature related to the great cardiac vein: Anatomical considerations and clinical implications for mitral isthmus block after vein of Marshall ethanol infusion. Heart Rhythm 2021; 18:1951-1958. [PMID: 34217842 DOI: 10.1016/j.hrthm.2021.06.1202] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/20/2021] [Accepted: 06/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Mitral isthmus gaps have been ascribed to an epicardial musculature anatomically related to the great cardiac vein (GCV) and the vein of Marshall (VOM). Their lumen offers an access for radiofrequency application or ethanol infusion, respectively. OBJECTIVE The purpose of this study was to evaluate the frequency of mitral isthmus gaps accessible via the GCV lumen, to assess their location around the GCV circumference, and to propose an efficient ablation strategy when present. METHODS One hundred consecutive patients underwent VOM ethanol infusion (step 1) and endocardial linear ablation from the mitral annulus to the left inferior pulmonary vein (step 2). In cases of mitral isthmus gap, endovascular ablation of the GCV anchored wall facing the left atrium was systematically performed (step 3), while the opposite GCV free wall was targeted in case of block failure only (step 4). RESULTS After VOM ethanol infusion and endocardial ablation, mitral isthmus block occurred in 51 patients (51%). Pacing maneuvers and activation sequences demonstrated an epicardial gap via the VOM in 2 patients (2%) and via the GCV in 47 patients (47%). In the latter case, block was achieved at the GCV anchored wall in 42 patients (89%) and the GCV free wall in 5 patients (11%). Global success rate of mitral isthmus block was 98%. No tamponade occurred. CONCLUSION With the advent of VOM ethanol infusion, residual mitral isthmus gaps are mostly eliminated within the first centimeter of the GCV. Thorough mapping of the entire circumference of the GCV wall can help identify these epicardial gaps.
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Affiliation(s)
- Thomas Pambrun
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France.
| | - Nicolas Derval
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Josselin Duchateau
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Arnaud Denis
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Rémi Chauvel
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Romain Tixier
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Nicolas Welte
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Clémentine André
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Takashi Nakashima
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Yosuke Nakatani
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Tsukasa Kamakura
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Takamitsu Takagi
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - F Daniel Ramirez
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Philipp Krisai
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Cyril Goujeau
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Ghassen Cheniti
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Konstantinos Vlachos
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Félix Bourier
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Masateru Takigawa
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Takeshi Kitamura
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Antonio Frontera
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Frédéric Sacher
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Michel Haïssaguerre
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
| | - Pierre Jaïs
- Unité d'Électrophysiologie Cardiaque, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de Rythmologie et Modélisation Cardiaque (LIRYC), University of Bordeaux, Bordeaux, France
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Lai Y, Liu X, Sang C, Long D, Li M, Ge W, Liu X, Lu Z, Guo Q, Jiang C, Zuo S, Jiang C, Bai R, Tang R, Guo X, Li S, Liu N, Wang W, Zhao X, Li C, Du X, Dong J, Ma C. Effectiveness of ethanol infusion into the vein of Marshall combined with a fixed anatomical ablation strategy (the "upgraded 2C3L" approach) for catheter ablation of persistent atrial fibrillation. J Cardiovasc Electrophysiol 2021; 32:1849-1856. [PMID: 34028114 DOI: 10.1111/jce.15108] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 12/28/2022]
Abstract
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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Affiliation(s)
- Yiwei Lai
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoxia Liu
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Caihua Sang
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Deyong Long
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Mengmeng Li
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Weili Ge
- Department of Cardiology, Taizhou Hospital of Zhejiang Province, Taizhou, China
| | - Xiangfei Liu
- Department of Cardiology, Shengli Oilfield Central Hospital, Dongying, Shandong, China
| | - Zhibing Lu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qi Guo
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Department of Cardiology, Taizhou Hospital of Zhejiang Province, Taizhou, China.,Department of Cardiology, Shengli Oilfield Central Hospital, Dongying, Shandong, China.,Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chao Jiang
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Song Zuo
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chenxi Jiang
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Rong Bai
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ribo Tang
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xueyuan Guo
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Songnan Li
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Nian Liu
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xin Zhao
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Changyi Li
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xin Du
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Changsheng Ma
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Ishimura M, Yamamoto M, Himi T, Kobayashi Y. Durability of mitral isthmus ablation with and without ethanol infusion in the vein of Marshall. J Cardiovasc Electrophysiol 2021; 32:2116-2126. [PMID: 34028116 DOI: 10.1111/jce.15107] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Ethanol infusion in the vein of Marshall (EIVOM) effectively creates a linear ablation lesion in the mitral isthmus (MI). However, data on the long-term success rates of MI ablation is limited. METHODS AND RESULTS Our cohort consisted of 560 patients with nonparoxysmal atrial fibrillation (AF) who underwent an initial MI ablation. Ablations were performed by only radiofrequency (RF) in 384 (RF group) or by RF and EIVOM in 176 (EIVOM/RF group) patients; 5 ml anhydrous ethanol was used to perform EIVOM in advance of RF. Following EIVOM, RF pulses were delivered to the lateral MI line. Bidirectional MI block was fully achieved in 353/384 (92%) (First 318, Re-do 35) patinents in the RF group and 171/176 (97%) (First 128, Re-do 43) patients in the EIVOM/RF group (p = .09 in the first, p = .10 in the re-do ablation cases). In cases with complete MI line block, recurrent AF or atrial tachycardia was observed in 130/353 (37%) patients in the RF group and in 64/171 (37%) patients in the EIVOM/RF group (log-rank p = .12 in the first, and p = .30 in the re-do ablation cases). Of the total 560 patients, 123 proceeded to the subsequent ablation session. Reconduction across MI line block was observed in 39/80 (49%) patients in the RF group and 25/43 (58%) patients in the EIVOM/RF group (p = .32). CONCLUSION EIVOM effectively ensures MI line block; however, the reconduction rate was similar between the two groups.
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Affiliation(s)
| | - Masashi Yamamoto
- Department of Cardiology, Kimitsu Central Hospital, Kisarazu, Japan
| | - Toshiharu Himi
- Department of Cardiology, Kimitsu Central Hospital, Kisarazu, Japan
| | - Yoshio Kobayashi
- Department of Cardiology, Chiba University Hospital, Chiba, Japan
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He Z, Yang L, Bai M, Yao Y, Zhang Z. Feasibility, efficacy, and safety of ethanol infusion into the vein of Marshall for atrial fibrillation: A meta-analysis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1151-1162. [PMID: 33990979 DOI: 10.1111/pace.14263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/24/2021] [Accepted: 05/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Contemporary radiofrequency catheter ablation (RFCA) approaches for atrial fibrillation (AF) have reached an efficacy "ceiling". Ethanol infusion into the vein of Marshall (EI-VOM) has shown potential in preliminary studies. Data on EI-VOM are largely limited to small single-center reports, and clinical benefits and risks have not been systematically examined. Therefore, we performed a meta-analysis to assess the feasibility, efficacy, and safety of EI-VOM for AF. METHODS All studies evaluating EI-VOM for AF were initially searched from four electronic search engines: PubMed, Web of Science, Cochrane Library, and SinoMed. We used RevMan5.4 to calculate pooled outcomes of randomized controlled trial and cohort studies. We also performed single-arm meta-analyses using Open Meta-Analyst. RESULTS We included a total of 10 studies with 1322 patients. Successful EI-VOM was performed in 86.7% (95% CI 81.9-91.4%) of patients. For persistent AF patients, the recurrence of AF and/or atrial tachycardia (AT) was significantly lower in the EI-VOM combined with RFCA group compared with RFCA alone group (RR 0.58, 95% CI 0.35 to 0.96, p = 0.04). EI-VOM combined with RFCA significantly increased the rate of bidirectional mitral isthmus block compared with RFCA alone in AF patients (RR 1.50, 95% CI 1.34 to 1.67, p < 0.001). There were nine cardiac tamponades observed in 644 patients (PR 0.8%, 95% CI 0.1-1.5%) who were performed EI-VOM combined with RFCA. CONCLUSIONS Our meta-analysis brings encouraging evidence that adjuvant EI-VOM reduces AF and/or AT recurrence rate in persistent AF patients and increases the success rate of bidirectional mitral isthmus block.
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Affiliation(s)
- Zhiyu He
- Heart Center, the First Hospital of Lanzhou University, Lanzhou, China.,the First Clinical Medical School, Lanzhou University, Lanzhou, China.,Gansu Key Laboratory of Cardiovascular Diseases, The First Hospital of Lanzhou University, Lanzhou, Gansu, China.,The Quality Improvement Project for the Diagnosis and Treatment of Complicated Cardiovascular and Cerebrovascular Diseases (2018), The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Lin Yang
- Department of Pathology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Ming Bai
- Heart Center, the First Hospital of Lanzhou University, Lanzhou, China.,Gansu Key Laboratory of Cardiovascular Diseases, The First Hospital of Lanzhou University, Lanzhou, Gansu, China.,The Quality Improvement Project for the Diagnosis and Treatment of Complicated Cardiovascular and Cerebrovascular Diseases (2018), The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Yali Yao
- Heart Center, the First Hospital of Lanzhou University, Lanzhou, China.,Gansu Key Laboratory of Cardiovascular Diseases, The First Hospital of Lanzhou University, Lanzhou, Gansu, China.,The Quality Improvement Project for the Diagnosis and Treatment of Complicated Cardiovascular and Cerebrovascular Diseases (2018), The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Zheng Zhang
- Heart Center, the First Hospital of Lanzhou University, Lanzhou, China.,the First Clinical Medical School, Lanzhou University, Lanzhou, China.,Gansu Key Laboratory of Cardiovascular Diseases, The First Hospital of Lanzhou University, Lanzhou, Gansu, China.,The Quality Improvement Project for the Diagnosis and Treatment of Complicated Cardiovascular and Cerebrovascular Diseases (2018), The First Hospital of Lanzhou University, Lanzhou, Gansu, China
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Lam A, Küffer T, Hunziker L, Nozica N, Asatryan B, Franzeck F, Madaffari A, Haeberlin A, Mühl A, Servatius H, Seiler J, Noti F, Baldinger SH, Tanner H, Windecker S, Reichlin T, Roten L. Efficacy and safety of ethanol infusion into the vein of Marshall for mitral isthmus ablation. J Cardiovasc Electrophysiol 2021; 32:1610-1619. [PMID: 33928711 DOI: 10.1111/jce.15064] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/31/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Chemical ablation by retrograde infusion of ethanol into the vein of Marshall (VOM-EI) can facilitate the achievement of mitral isthmus block. This study sought to describe the efficacy and safety of this technique. METHODS AND RESULTS Twenty-two consecutive patients (14 males, median age 71 years) with attempted VOM-EI for mitral isthmus ablation were included in the study. VOM-EI was successfully performed with a median of 4 ml of 96% ethanol in 19 patients (86%) and the mitral isthmus was successfully blocked in all (100%). Touch up endocardial and/or epicardial ablation after VOM-EI was necessary for 12 patients (63%). Perimitral flutter was present in 12 patients (63%) during VOM-EI and terminated or slowed by VOM-EI in 4 and 3 patients, respectively. The low-voltage area of the mitral isthmus region increased from 3.1 cm2 (interquartile range [IQR] 0-7.9) before to 13.2 cm2 (IQR: 8.2-15.0) after VOM-EI and correlated significantly with the volume of ethanol injected (p = .03). Median high-sensitive cardiac troponin-T increased significantly from 330 ng/L (IQR: 221-516) the evening of the procedure to 598 ng/L (IQR: 382-769; p = .02) the following morning. A small pericardial effusion occurred in three patients (16%), mild pericarditis in one (5%), and uneventful VOM dissection in two (11%). After a median follow-up of 3.5 months (IQR: 3.0-11.0), 10 of 18 patients (56%) with VOM-EI and available follow-up had arrhythmia recurrence. Repeat ablation was performed in five patients (50%) and peri-mitral flutter diagnosed in three (60%). CONCLUSION VOM-EI is feasible, safe, and effective to achieve acute mitral isthmus block.
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Affiliation(s)
- Anna Lam
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Thomas Küffer
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Lukas Hunziker
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Nikolas Nozica
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Florian Franzeck
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Aline Mühl
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Samuel H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
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Vlachos K, Derval N, Pambrun T, Duchateau J, Martin CA, Bazoukis G, Frontera A, Takigawa M, Nakashima T, Efremidis M, Letsas KP, Bourier F, André C, Krisai P, Ramirez FD, Kamakura T, Takagi T, Nakatani Y, Tixier R, Chauvel R, Welte N, Kitamura T, Cheniti G, Sacher F, Jaïs P, Haïssaguerre M, Hocini M. Ligament of Marshall ablation for persistent atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:782-791. [PMID: 33687764 DOI: 10.1111/pace.14208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 02/09/2021] [Accepted: 02/28/2021] [Indexed: 11/29/2022]
Abstract
Beyond pulmonary vein isolation, the two main additional strategies: Cox-Maze procedure or targeting of electrical signatures (focal bursts, rotational activities, meandering wavelets), remain controversial. High-density mapping of these arrhythmias has demonstrated firstly that a patchy lesion set is highly proarrhythmogenic, favoring macro-re-entry through conduction slowing and providing pivots for localized re-entry. Secondly, discrete anatomical structures such as the Vein or Ligament of Marshall (VOM/LOM) and the coronary sinus (CS) have epicardial muscular bundles that are more frequently involved in re-entry than previously thought. The Marshall Bundle can be ablated at any point along its course from the mid-to-distal coronary sinus to the left atrial appendage. If necessary, the VOM may be directly ablated using ethanol infusion to eliminate PV contributions and produce conduction block across the mistral isthmus. Ethanol ablation of the VOM, supplemented with RF ablation, may be more effective in producing conduction block at the mitral isthmus than repeat RF ablation alone.
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Affiliation(s)
- Konstantinos Vlachos
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Nicolas Derval
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Thomas Pambrun
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Josselin Duchateau
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Claire A Martin
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France.,Cardiology Department, Royal Papworth Hospital, Cambridge, UK
| | - George Bazoukis
- Arrhythmia Unit, Laboratory of Cardiac Electrophysiology, Second Cardiology Department, Evangelismos General Hospital of Athens, Greece
| | - Antonio Frontera
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Masateru Takigawa
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Takashi Nakashima
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Michael Efremidis
- Arrhythmia Unit, Laboratory of Cardiac Electrophysiology, Second Cardiology Department, Evangelismos General Hospital of Athens, Greece.,Onassis Cardiac Surgery Centre, Athens, Greece
| | - Konstantinos P Letsas
- Arrhythmia Unit, Laboratory of Cardiac Electrophysiology, Second Cardiology Department, Evangelismos General Hospital of Athens, Greece
| | - Felix Bourier
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Clémentine André
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Philipp Krisai
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - F Daniel Ramirez
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Tsukasa Kamakura
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Takamitsu Takagi
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Yosuke Nakatani
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Romain Tixier
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Remi Chauvel
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Nicolas Welte
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Takeshi Kitamura
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Ghassen Cheniti
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Frédéric Sacher
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Pierre Jaïs
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Michel Haïssaguerre
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Mélèze Hocini
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
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47
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Takagi T, Pambrun T, Nakashima T, Vlachos K, André C, Krisai P, Ramirez FD, Kamakura T, Nakatani Y, Cheniti G, Tixier R, Chauvel R, Duchateau J, Sacher F, Cochet H, Hocini M, Haïssaguerre M, Jaïs P, Derval N. Significance of manifest localized staining during ethanol infusion into the vein of Marshall. Heart Rhythm 2021; 18:1057-1063. [PMID: 33741483 DOI: 10.1016/j.hrthm.2021.03.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/02/2021] [Accepted: 03/11/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Localized staining due to venule injury is attributable to ethanol infusion into the vein of Marshall (Et-VOM). OBJECTIVE The purpose of this study was to investigate adverse outcomes of localized staining during Et-VOM in patients undergoing ablation for atrial fibrillation. METHODS Two hundred four patients (age 64 ± 10 years; 153 male) were sorted based on the aspect of localized staining. Staining of atrial myocardium that spread uniformly along the VOM vascular tree following selective VOM venography was considered normal, in contrast to predominantly localized staining that spread concentrically from a focal point due to vascular injury. Outcomes between the 2 groups were compared. RESULTS Localized staining was observed in 27% of patients. No patients developed clinically significant pericardial effusions during Et-VOM; however, 7 patients developed pericardial effusions on the first postprocedural day (3.6% in patients with vs 3.4% in patients without localized staining). No significant difference was found in achievement of acute mitral isthmus (MI) block (96% vs 98%) and size of the endocardial low-voltage area (8.5 ± 4.1 cm2 vs 9.3 ± 5.3 cm2) in patients with and without localized staining, respectively. Long-term follow-up was not impacted by localized staining. Freedom from recurrent atrial tachyarrhythmias (66% vs 76%) and durability of MI block (57% vs 54%) were not significantly different with and without localized staining. There were no cases of rehospitalization for pericarditis, chronic pericardial effusion, or heart failure. CONCLUSION In our study, localized staining was frequent but was not associated with clinically relevant impact or disadvantages.
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Affiliation(s)
- Takamitsu Takagi
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France.
| | - Thomas Pambrun
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Takashi Nakashima
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Konstantinos Vlachos
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Clémentine André
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Philipp Krisai
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - F Daniel Ramirez
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Tsukasa Kamakura
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Yosuke Nakatani
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Ghassen Cheniti
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Romain Tixier
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Remi Chauvel
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Josselin Duchateau
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Frédéric Sacher
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Hubert Cochet
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Michel Haïssaguerre
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Pierre Jaïs
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Nicolas Derval
- Electrophysiology and Ablation Unit, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
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48
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Krisai P, Pambrun T, Nakatani Y, Nakashima T, Takagi T, Kamakura T, André C, Cheniti G, Tixier R, Chauvel R, Duchateau J, Sacher F, Haïssaguerre M, Cochet H, Jaïs P, Derval N, Hocini M. How to perform ethanol ablation of the vein of Marshall for treatment of atrial fibrillation. Heart Rhythm 2021; 18:1083-1087. [PMID: 33601037 DOI: 10.1016/j.hrthm.2021.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/03/2021] [Accepted: 02/06/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Philipp Krisai
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France.
| | - Thomas Pambrun
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Yosuke Nakatani
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Takashi Nakashima
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Takamitsu Takagi
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Tsukasa Kamakura
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Clémentine André
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Ghassen Cheniti
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Romain Tixier
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Rémi Chauvel
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Josselin Duchateau
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Frédéric Sacher
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Michel Haïssaguerre
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Hubert Cochet
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Pierre Jaïs
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Nicolas Derval
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Mélèze Hocini
- Electrophysiology and Ablation Unit and LIRYC, CHU de Bordeaux, Bordeaux-Pessac, France
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Lador A, Peterson LE, Swarup V, Schurmann PA, Makkar A, Doshi RN, DeLurgio D, Athill CA, Ellenbogen KA, Natale A, Koneru J, Dave AS, Giorgberidze I, Afshar H, Guthrie ML, Bunge R, Morillo CA, Kleiman NS, Valderrábano M. Determinants of outcome impact of vein of Marshall ethanol infusion when added to catheter ablation of persistent atrial fibrillation: A secondary analysis of the VENUS randomized clinical trial. Heart Rhythm 2021; 18:1045-1054. [PMID: 33482387 DOI: 10.1016/j.hrthm.2021.01.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/01/2021] [Accepted: 01/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Vein of Marshall Ethanol for Untreated Persistent AF (VENUS) trial demonstrated that adding vein of Marshall (VOM) ethanol infusion to catheter ablation (CA) improves ablation outcomes in persistent atrial fibrillation (AF). There was significant heterogeneity in the impact of VOM ethanol infusion on rhythm control. OBJECTIVE The purpose of this study was to assess the association between outcomes and (1) achievement of bidirectional perimitral conduction block and (2) procedural volume. METHODS The VENUS trial randomized patients with persistent AF (N = 343) to CA combined with VOM ethanol or CA alone. The primary outcome (freedom from AF or atrial tachycardia [AT] lasting longer than 30 seconds after a single procedure) was analyzed by 2 categories: (1) successful vs no perimitral block and (2) high- (>20 patients enrolled) vs low-volume centers. RESULTS In patients with perimitral block, the primary outcome was reached 54.3% after VOM-CA and 37% after CA alone (P = .01). Among patients without perimitral block, freedom from AF/AT was 34.0% after VOM-CA and 37.0% after CA (P = .583). In high-volume centers, the primary outcome was reached in 56.4% after VOM-CA and 40.2% after CA (P = .01). In low-volume centers, freedom from AF/AT was 30.77% after VOM-CA and 32.61% after CA (P = .84). In patients with successful perimitral block from high-volume centers, the primary outcome was reached in 59% after VOM-CA and 39.1% after CA (P = .01). Tests for interaction were significant (P = .002 for perimitral block and P = .04 for center volume). CONCLUSION Adding VOM ethanol infusion to CA has a greater impact on outcomes when associated with perimitral block and performed in high-volume centers. Perimitral block should be part of the VOM procedure.
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Affiliation(s)
- Adi Lador
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | - Leif E Peterson
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | | | - Paul A Schurmann
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas; Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | | | - Rahul N Doshi
- Division of Cardiology, Keck-USC University Hospital, University of Southern California, Los Angeles, California
| | - David DeLurgio
- Division of Cardiology, Emory St. Joseph's Hospital, Emory University, Atlanta, Georgia
| | - Charles A Athill
- San Diego Cardiac Center, Sharp Memorial Hospital, San Diego, California
| | - Kenneth A Ellenbogen
- Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas
| | - Jayanthi Koneru
- Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Amish S Dave
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | | | - Hamid Afshar
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Michelle L Guthrie
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | - Raquel Bunge
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | - Carlos A Morillo
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | - Miguel Valderrábano
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas.
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