Cunn Gregory, Patel Apoor, Coleman Kristie, Dulmovits Eric, Skipitaris Nicholas, Epstein Laurence, Mountantonakis Stavros, Beldner Stuart
Department of Cardiology, Northshore University Hospital, Manhasset, NY, USA.
Department of Cardiology, Houston Methodist Hospital, Houston, TX, USA.
J Interv Card Electrophysiol. 2025 Jan;68(1):65-71. doi: 10.1007/s10840-024-01877-w. Epub 2024 Jul 30.
Vein of Marshall (VoM) ethanol ablation has a proven benefit in patients with persistent atrial fibrillation (AF) undergoing index procedure; however, its role in repeat ablation is unknown. We sought to evaluate the benefit of empiric VoM ethanol ablation in addition to posterior wall isolation (PWI) during the repeat procedure in patients with durable pulmonary vein (PV) isolation from prior ablation.
Twenty-three patients (age 67.1 + / - 7.4, 74% males) who received empiric VoM ethanol infusion in addition to PWI were matched for age, gender, ejection fraction, and left atrial size with forty-six patients receiving empiric PWI alone. All patients in the study group underwent additional ablation on mitral isthmus to complete the lateral mitral isthmus line. Additional ablation was based on program and trigger stimulation. Primary outcome was freedom from AF after a blanking period of 3 months by qualification of symptoms, EKG, wearable, or implantable monitor or device.
The study group had a higher average BMI (35.07 + / - 8.98 vs. 30.85 + / - 5.65, p = 0.033) and rate of persistent AF (83.0% vs. 54.3%, p = 0.029) versus the control. The 1-year AF-free survival for the study and control groups was 20 (86.96%) and 28 (60.1%) patients (p = 0.027). Cox proportional hazard regression analysis showed a significant reduction in AF recurrence in the study group (HR 0.25, 95% CI 0.073-0.843, p = 0.026).
Among patients undergoing repeat catheter ablation for recurrent AF with durably isolated PVs, the addition of VoM ethanol infusion increased the likelihood of remaining free from AF at 12 months.
马歇尔静脉（VoM）乙醇消融已被证实对接受初次手术的持续性心房颤动（AF）患者有益；然而，其在重复消融中的作用尚不清楚。我们试图评估在先前消融后肺静脉（PV）实现持久隔离的患者进行重复手术时，除后壁隔离（PWI）外经验性VoM乙醇消融的益处。
23例（年龄67.1±7.4岁，74%为男性）除接受PWI外还接受经验性VoM乙醇输注的患者，在年龄、性别、射血分数和左心房大小方面与46例仅接受经验性PWI的患者进行匹配。研究组的所有患者均在二尖瓣峡部进行额外消融以完成二尖瓣峡部外侧线。额外消融基于程序和触发刺激。主要结局是在3个月的空白期后，通过症状、心电图、可穿戴或植入式监测器或设备判定无AF。
与对照组相比，研究组的平均体重指数更高（3
