Acute mitral isthmus block during catheter ablation with vein of Marshall ethanol infusion: Angiographic considerations - 17/02/24
, Grégoire Massoulié a
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Graphical abstract |
Highlights |
• | 149 consecutive patients with long-standing AF or peri-mitral flutter ablation. |
• | EIVOM was feasible in 82% of cases. |
• | Systematic EIVOM achieved complete MIB in 94% of feasible cases. |
• | Systematic EIVOM achieved complete MIB in 77% of the total population. |
• | No major complications during the procedure or postprocedural monitoring. |
• | Failure to obtain MIB linked with increased MI length and high left atrial volume. |
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.
Le texte complet de cet article est disponible en PDF.Keywords : Atrial fibrillation, Mitral isthmus line ablation, Vein of Marshall, Ethanol infusion
Plan
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Vol 117 - N° 2
P. 119-127 - février 2024 Retour au numéro
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