Luo Tao, Liu Tao, Cui Bo, Li Xi, Zhang Jinlin, Wu Gang
Department of Cardiology, Renmin Hospital of Wuhan University, 430060 Wuhan, Hubei, China.
Cardiovascular Research Institute, Wuhan University, 430060 Wuhan, Hubei, China.
Rev Cardiovasc Med. 2023 Oct 23;24(10):302. doi: 10.31083/j.rcm2410302. eCollection 2023 Oct.
Radiofrequency catheter ablation (RFCA) has been shown to have low efficacy for the treatment of persistent atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM). We conducted this study to evaluate the benefit of adjunctive vein of Marshall (VOM) ethanol infusion during RFCA for persistent AF (PsAF) in patients with non-obstructive HCM.
This multicenter retrospective observational study included 102 consecutive non-obstructive HCM patients with PsAF who underwent RFCA plus VOM ethanol infusion (VOM-EI) (RFCA + VOM, n = 56) or RFCA alone (RFCA, n = 46) for the first time. The efficacy endpoint was survival without AF or atrial tachycardia (AT) after the blanking period.
We completed the VOM-EI in 92.9% (52/56) patients. The left pulmonary vein antrum ablation time (RFCA + VOM: 19.9 6.1 min vs. RFCA: 27.2 9.3 min), mitral isthmus (MI) ablation time (RFCA + VOM: 16.9 3.7 min vs. RFCA: 28.4 7.8 min), and rate of coronary sinus (CS) vein ablation (RFCA + VOM: 57.69% vs. RFCA: 80.43%) were lower but the acute success rate of MI block (RFCA + VOM: 98.1% vs. RFCA: 84.8%) were higher in the RFCA + VOM group than those in the RFCA group (all 0.05). After twelve months follow-up, 84.6% of patients (44/52) survived without AF/AT in the RFCA + VOM group, compared to 65.2% of patients (30/46) in the RFCA group ( = 0.03; odds ratio = 2.93, 95% CI: 1.18-7.79).
VOM-EI combined with RFCA decreased the recurrence rate of AF/AT at 12 months in HCM patients with PsAF. VOM-EI simplified the ablation of the left pulmonary vein antrum and MI and increased the success rate of MI bidirectional block.
射频导管消融术（RFCA）已被证明对肥厚型心肌病（HCM）患者的持续性心房颤动（AF）治疗效果不佳。我们开展本研究以评估在非梗阻性HCM患者的持续性AF（PsAF）的RFCA过程中，辅助注入Marshall静脉（VOM）乙醇的益处。
这项多中心回顾性观察研究纳入了102例首次接受RFCA联合VOM乙醇注入（VOM-EI）（RFCA + VOM组，n = 56）或单纯RFCA（RFCA组，n = 46）的连续非梗阻性HCM合并PsAF患者。疗效终点为空白期后无AF或房性心动过速（AT）存活。
我们在92.9%（52/56）的患者中完成了VOM-EI。RFCA + VOM组的左肺静脉前庭消融时间（RFCA + VOM组：19.9±6.1分钟 vs. RFCA组：27.2±9.3分钟）、二尖瓣峡部（MI）消融时间（RFCA + VOM组：16.9±3.7分钟 vs. RFCA组：28.4±7.8分钟）和冠状窦（CS）静脉消融率（RFCA + VOM组：57.69% vs. RFCA组：80.43%）较低，但RFCA + VOM组的MI阻滞急性成功率（RFCA + VOM组：98.1% vs. RFCA组：84.8%）高于RFCA组（均P<0.05）。随访12个月后，RFCA + VOM组84.6%的患者（44/52）无AF/AT存活，而RFCA组为65.2%的患者（30/46）（P = 0.03；优势比 = 2.93，95%CI：1.18 - 7.79）。
VOM-EI联合RFCA降低了非梗阻性HCM合并PsAF患者12个月时AF/AT的复发率。VOM-EI简化了左肺静脉前庭和MI的消融，并提高了MI双向阻滞的成功率。
