Kong Lingcong, Shuang Tian, Li Zheng, Zou Zhiguo, Pu Jun, Wang Xin-Hua
Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Cardiovasc Med. 2022 Oct 4;9:1031673. doi: 10.3389/fcvm.2022.1031673. eCollection 2022.
Ethanol infusion into the VOM (EIVOM) adjunctive to radiofrequency catheter ablation (RFCA) was a novel approach facilitating mitral isthmus (MIth) block for persistent atrial fibrillation (PeAF); However, there were remarkable disparities in its technical aspects. This study aimed to evaluate the impact of EIVOM technical aspects on acute MIth block.
Eighty consecutive patients (63 males, average age 66.4 ± 8.6 years) undergoing PeAF ablation were assigned to different groups. The procedural parameters in "EIVOM first" ( = 13) or "RFCA first" ( = 13) as well as small dose ([SD], ≤4 ml, = 26) or big dose ([BD], >4 ml, = 54) approaches were analyzed to identify the predictors for acute MIth block.
Compared with the "EIVOM first" approach, the "RFCA first" approach was associated with longer procedural and MIth ablation time (134 ± 27 min vs. 112 ± 17 min; 14.9 ± 5.5 min vs. 9.3 ± 5.1 min, both < 0.05, respectively), but with comparable success of MIth block. The ethanol dose was 6.3 ± 1.5 ml in BD group vs. 3.1 ± 1.0 ml in SD group ( < 0.001) and was correlated significantly with the size of Δlow voltage area ( = 0.66, < 0.001). The success of MIth block was 92.6% in BD group vs. 73.1% in SD group, = 0.03. The ethanol dose >5.75 ml independently predicted successful MIth block (OR: 0.428, 95% CI: 0.219-0.839, = 0.01).
Despite the comparable effectiveness on MIth block, the "EIVOM first" approach was associated with shorter procedural and MIth ablation time than the "RFCA first" approach. The ethanol dose in EIVOM was an independent predictor for MIth block.
在射频导管消融术（RFCA）辅助下向二尖瓣峡部（VOM）注入乙醇（EIVOM）是促进持续性心房颤动（PeAF）患者二尖瓣峡部（MIth）阻滞的一种新方法；然而，其技术方面存在显著差异。本研究旨在评估EIVOM技术方面对急性MIth阻滞的影响。
将80例连续接受PeAF消融的患者（63例男性，平均年龄66.4±8.6岁）分为不同组。分析“先EIVOM”组（n = 13）或“先RFCA”组（n = 13）以及小剂量（[SD]，≤4 ml，n = 26）或大剂量（[BD]，>4 ml，n = 54）方法的手术参数，以确定急性MIth阻滞的预测因素。
与“先EIVOM”方法相比，“先RFCA”方法的手术时间和MIth消融时间更长（分别为134±27分钟 vs. 112±17分钟；14.9±5.5分钟 vs. 9.3±5.1分钟，均P<0.05），但MIth阻滞成功率相当。BD组乙醇剂量为6.3±1.5 ml，SD组为3.1±1.0 ml（P<0.001），且与低电压区大小显著相关（r = 0.66，P<0.001）。BD组MIth阻滞成功率为92.6%，SD组为73.1%，P = 0.03。乙醇剂量>5.75 ml可独立预测MIth阻滞成功（OR：0.428，95%CI：0.219 - 0.839，P = 0.01）。
尽管在MIth阻滞方面效果相当，但“先EIVOM”方法与“先RFCA”方法相比，手术时间和MIth消融时间更短。EIVOM中的乙醇剂量是MIth阻滞的独立预测因素。
