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.
Adolescent
Adult
Aged
Aged, 80 and over
Atrial Fibrillation
/ physiopathology
Catheter Ablation
/ methods
Ethanol
/ administration & dosage
Female
Heart Conduction System
/ physiopathology
Heart Rate
/ physiology
Humans
Infusions, Intravenous
Male
Middle Aged
Pulmonary Veins
/ surgery
Recurrence
Treatment Outcome
Young Adult
Catheter ablation
Ethanol
Mitral isthmus
Persistent atrial fibrillation
Vein of Marshall
Journal
Heart rhythm
ISSN: 1556-3871
Titre abrégé: Heart Rhythm
Pays: United States
ID NLM: 101200317
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
received:
19
11
2020
revised:
01
01
2021
accepted:
05
01
2021
pubmed:
23
1
2021
medline:
11
2
2022
entrez:
22
1
2021
Statut:
ppublish
Résumé
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. The purpose of this study was to assess the association between outcomes and (1) achievement of bidirectional perimitral conduction block and (2) procedural volume. 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. 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). 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.
Sections du résumé
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.
Identifiants
pubmed: 33482387
pii: S1547-5271(21)00005-9
doi: 10.1016/j.hrthm.2021.01.005
pmc: PMC8254797
mid: NIHMS1664438
pii:
doi:
Substances chimiques
Ethanol
3K9958V90M
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1045-1054Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL115003
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
Références
J Am Coll Cardiol. 2014 May 13;63(18):1892-901
pubmed: 24561151
Circ Arrhythm Electrophysiol. 2020 Dec;13(12):e008884
pubmed: 33197321
JAMA. 2020 Oct 27;324(16):1620-1628
pubmed: 33107945
N Engl J Med. 2015 May 7;372(19):1812-22
pubmed: 25946280
Heart Rhythm. 2012 Aug;9(8):1207-15
pubmed: 22406143
Circ Arrhythm Electrophysiol. 2012 Apr;5(2):287-94
pubmed: 22139886
J Arrhythm. 2017 Oct;33(5):369-409
pubmed: 29021841
Circ Arrhythm Electrophysiol. 2009 Feb;2(1):50-6
pubmed: 19756206
N Engl J Med. 1998 Sep 3;339(10):659-66
pubmed: 9725923
J Cardiovasc Electrophysiol. 2006 Oct;17(10):1106-11
pubmed: 16911579
JACC Clin Electrophysiol. 2017 Sep;3(9):1020-1032
pubmed: 29759706
J Cardiovasc Electrophysiol. 2012 Jun;23(6):583-91
pubmed: 22429895
Am Heart J. 2019 Sep;215:52-61
pubmed: 31279972
Heart Rhythm. 2010 Jan;7(1):2-8
pubmed: 19962945