Mhanna Mohammed, Beran Azizullah, Al-Abdouh Ahmad, Sajdeya Omar, Altujjar Mohammed, Alom Modar, M Abumoawad Abdelrhman, M Elzanaty Ahmed, Chacko Paul, A Eltahawy Ehab
Department of Internal Medicine, The University of Toledo, Toledo, OH, USA.
Department of Internal Medicine, Saint Agnes Hospital, Baltimore, MD, USA.
J Atr Fibrillation. 2021 Jun 30;14(1):20200492. doi: 10.4022/jafib.20200492. eCollection 2021 Jun-Jul.
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.
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.
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).
Our meta-analysis demonstrated that adjunctive VOM-EI strategy is more effective than conventional catheter ablation with similar safety profiles.
心房颤动（AF）的导管消融（CA）疗效可能有限。由于Marshall静脉（VOM）存在自主神经支配，其是房颤消融术中一个有吸引力的靶点。在这项荟萃分析中，我们旨在评估VOM辅助乙醇注入（VOM-EI）在房颤消融中的疗效和安全性。
我们对评估VOM-EI与单纯房颤导管消融相比在房颤消融中的疗效和安全性的研究进行了全面的文献检索。主要关注的结局是晚期（≥3个月）房颤或房性心动过速（AT）复发。次要结局包括急性二尖瓣峡部双向阻滞（MIBB）和手术并发症（心包积液、中风或房室食管瘘）。使用随机效应模型计算合并相对风险（RR）和相应的95%置信区间（CI）。
最终分析纳入了4项研究，共804例房颤患者（68.2%为持续性房颤，平均年龄63.5±9.9岁，401例患者接受VOM-EI加CA，403例患者仅接受CA）。VOM-EI组晚期房颤/AT复发风险较低（RR：0.63；95%CI：0.46-0.87；P = 0.005），实现急性MIBB的概率增加（RR：1.39；95%CI：1.08-1.79；P = 0.009），且手术并发症未增加（RR：1.05；95%CI：0.57-1.94；P = 0.87）。
我们的荟萃分析表明，VOM-EI辅助策略比传统导管消融更有效，且安全性相似。
