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.
atrial fibrillation
catheter ablation
ethanol infusion
recurrence
vein of Marshall
Journal
Journal of cardiovascular electrophysiology
ISSN: 1540-8167
Titre abrégé: J Cardiovasc Electrophysiol
Pays: United States
ID NLM: 9010756
Informations de publication
Date de publication:
06 2022
06 2022
Historique:
revised:
22
02
2022
received:
19
11
2021
accepted:
28
02
2022
pubmed:
30
3
2022
medline:
10
6
2022
entrez:
29
3
2022
Statut:
ppublish
Résumé
The optimal strategy after a failed ablation for persistent atrial fibrillation (perAF) is unknown. This study evaluated the value of an anatomically guided strategy using a systematic set of linear lesions with adjunctive ethanol infusion into the vein of Marshall (Et-VOM) in patients referred for second perAF ablation procedures. Patients with perAF who underwent a second procedure were grouped according to the two strategies. The first strategy was an anatomically guided approach using systematic linear ablation with adjunctive Et-VOM, with bidirectional blocks at the posterior mitral isthmus (MI), roof, and cavotricuspid isthmus (CTI) as the procedural endpoint (Group I). The second one was an electrophysiology-guided strategy, with atrial tachyarrhythmia termination as the procedural endpoint (Group II). Arrhythmia behavior during the procedure guided the ablation strategy. Groups I and II consisted of 96 patients (65 ± 9 years; 71 men) and 102 patients (63 ± 10 years; 83 men), respectively. Baseline characteristics were comparable. In Group I, Et-VOM was successfully performed in 91/96 (95%), and procedural endpoint (bidirectional block across all three anatomical lines) was achieved in 89/96 (93%). In Group II, procedural endpoint (atrial tachyarrhythmia termination) was achieved in 80/102 (78%). One-year follow-up demonstrated Group I (21/96 [22%]) experienced less recurrence compared to Group II (38/102 [37%], Log-rank p = .01). This was driven by lower AT recurrence in Group I (Group I: 10/96 [10%] vs. Group II: 29/102 [28%]; p = .002). Anatomically guided strategy with adjunctive Et-VOM is superior to an electrophysiology-guided strategy for second procedures in patients with perAF at 1-year follow-up.
Substances chimiques
Ethanol
3K9958V90M
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1116-1124Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022 Wiley Periodicals LLC.
Références
Verma A, Jiang C-Y, Betts TR, et al. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med. 2015;372:1812-1822.
Rostock T, Salukhe TV, Steven D, et al. Long-term single- and multiple-procedure outcome and predictors of success after catheter ablation for persistent atrial fibrillation. Heart Rhythm. 2011;8:1391-1397.
Scherr D, Khairy P, Miyazaki S, et al. Five-year outcome of catheter ablation of persistent atrial fibrillation using termination of atrial fibrillation as a procedural endpoint. Circ Arrhythm Electrophysiol. 2015;8:18-24.
Dong JZ, Sang CH, Yu RH, et al. Prospective randomized comparison between a fixed ‘2C3L’ approach vs. stepwise approach for catheter ablation of persistent atrial fibrillation. Europace. 2015;17:1798-1806.
Schreiber D, Rostock T, Fröhlich M, et al. Five-year follow-up after catheter ablation of persistent atrial fibrillation using the stepwise approach and prognostic factors for success. Circ Arrhythm Electrophysiol. 2015;8:308-317.
Derval N, Duchateau J, Denis A, et al. Marshall bundle elimination, Pulmonary vein isolation, and Line completion for ANatomical ablation of persistent atrial fibrillation (Marshall-PLAN): prospective, single-center study. Heart Rhythm. 2021;18:529-537.
Hocini M, Jaïs P, Sanders P, et al. Techniques, evaluation, and consequences of linear block at the left atrial roof in paroxysmal atrial fibrillation: a prospective randomized study. Circulation. 2005;112:3688-3696.
Ammar-Busch S, Kaess BM, Bruhm A, et al. Atrial tachycardias following persistent atrial fibrillation ablation: predictors of recurrence after the repeat ablation. J Cardiovasc Electrophysiol. 2015;26:1315-1320.
Derval N, Takigawa M, Frontera A, et al. Characterization of complex atrial tachycardia in patients with previous atrial interventions using high-resolution mapping. JACC Clin Electrophysiol. 2020;6:815-826.
Arbelo E, Brugada J, Hindricks G, et al. The atrial fibrillation ablation pilot study: a European Survey on Methodology and results of catheter ablation for atrial fibrillation conducted by the European Heart Rhythm Association. Eur Heart J. 2014;35:1466-1478.
Chugh A, Oral H, Lemola K, et al. Prevalence, mechanisms, and clinical significance of macroreentrant atrial tachycardia during and following left atrial ablation for atrial fibrillation. Heart Rhythm. 2005;2:464-471.
Vlachos K, Denis A, Takigawa M, et al. The role of Marshall bundle epicardial connections in atrial tachycardias after atrial fibrillation ablation. Heart Rhythm. 2019;16:1341-1347.
Takigawa M, Derval N, Martin CA, et al. Mechanism of recurrence of atrial tachycardia: comparison between first versus redo procedures in a high-resolution mapping system. Circ Arrhythm Electrophysiol. 2020;13:e007273.
Valderrábano M, Chen HR, Sidhu J, Rao L, Ling Y, Khoury DS. Retrograde ethanol infusion in the vein of Marshall: regional left atrial ablation, vagal denervation and feasibility in humans. Circ Arrhythm Electrophysiol. 2009;2:50-56.
Lai Y, Liu X, Sang C, et al. 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.
Pambrun T, Denis A, Duchateau J, et al. MARSHALL bundles elimination, Pulmonary veins isolation and Lines completion for ANatomical ablation of persistent atrial fibrillation: MARSHALL-PLAN case series. J Cardiovasc Electrophysiol. 2019;30:7-15.
Nakashima T, Pambrun T, Vlachos K, et al. Impact of vein of Marshall ethanol infusion on mitral isthmus block: efficacy and durability. Circ Arrhythm Electrophysiol. 2020;13:e008884.
Sawhney N, Anand K, Robertson CE, Wurdeman T, Anousheh R, Feld GK. Recovery of mitral isthmus conduction leads to the development of macro-reentrant tachycardia after left atrial linear ablation for atrial fibrillation. Circ Arrhythm Electrophysiol. 2011;4:832-837.
Takigawa M, Vlachos K, Martin CA, et al. Acute and mid-term outcome of ethanol infusion of vein of Marshall for the treatment of perimitral flutter. Europace. 2020;22:1252-1260.
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.
Liu CM, Lo LW, Lin YJ, et al. Long-term efficacy and safety of adjunctive ethanol infusion into the vein of Marshall during catheter ablation for nonparoxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2019;30:1215-1228.
Báez-Escudero JL, Keida T, Dave AS, Okishige K, Valderrábano M. Ethanol infusion in the vein of Marshall leads to parasympathetic denervation of the human left atrium: implications for atrial fibrillation. J Am Coll Cardiol. 2014;63:1892-1901.
Dave AS, Báez-Escudero JL, Sasaridis C, Hong TE, Rami T, Valderrábano M. Role of the vein of Marshall in atrial fibrillation recurrences after catheter ablation: therapeutic effect of ethanol infusion. J Cardiovasc Electrophysiol. 2012;23:583-591.
Valderrábano M, Peterson LE, Swarup V, et al. Effect of catheter ablation with vein of marshall ethanol infusion vs catheter ablation alone on persistent atrial fibrillation: the VENUS Randomized Clinical Trial. JAMA. 2020;324:1620-1628.
Valderrábano M, Peterson LE, Bunge R, et al. Vein of Marshall ethanol infusion for persistent atrial fibrillation: VENUS and MARS clinical trial design. Am Heart J. 2019;215:52-61.