马歇尔静脉乙醇辅助输注对心房颤动导管消融结局的影响：一项系统评价和荟萃分析

Impact of Adjunctive Vein of Marshall Ethanol Infusion on Catheter Ablation Outcomes in Atrial Fibrillation: A Systematic Review and Meta-Analysis.

作者信息

Itaya Eduardo Dan, Ternes Caique M P, Rivera André, de Carvalho Lara Melo Soares Pinho, D'Angelo Robert, d'Avila Andre

机构信息

Department of Internal Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA.

Department of Medicine, Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA.

出版信息

J Cardiovasc Electrophysiol. 2025 Sep 14. doi: 10.1111/jce.70100.

DOI:10.1111/jce.70100

PMID:40947530

Abstract

BACKGROUND

Catheter ablation (CA) for atrial fibrillation (AF) has limited efficacy. The vein of Marshall (VOM) is associated with autonomic innervation and has arrhythmogenic roles in AF, which can be ablated with ethanol infusion. However, the impact of VOM ethanol infusion (VOMEI) on the recurrence of atrial tachyarrhythmia (ATA) remains unclear.

METHODS

We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) and observational studies comparing CA with versus without VOMEI in patients with AF. Outcomes were ATA recurrence and mitral isthmus (MI) block rate. ATA recurrence was defined as AF, atrial flutter, or atrial tachycardia following the index procedure. Sensitivity analyses were performed after restricting to patients with persistent AF, undergoing a re-do procedure, and RCTs.

RESULTS

This meta-analysis included 4 RCTs and 16 observational studies, comprising a total of 4732 patients, of whom 2105 (44%) underwent VOMEI. The mean follow-up ranged from 12 to 46.8 months. Compared with CA alone, VOMEI was associated with a significantly lower ATA recurrence (OR: 0.51; 95% CI: 0.40-0.65; p < 0.01) and significantly higher rates of MI block rate (OR: 4.41; 95% CI: 2.47-7.88; p < 0.01). Subgroup analysis also revealed significantly lower ATA recurrence with adjunctive VOMEI in patients with persistent AF at baseline (OR: 0.47; 95% CI: 0.35-0.64; p < 0.01), those undergoing a re-do procedure (OR: 0.44; 95% CI: 0.33-0.61; p < 0.01), and after restricting to RCTs (OR: 0.58; 95% CI: 0.44-0.76; p < 0.01).

CONCLUSION

In patients with AF, adjunctive VOMEI combined with CA was associated with reduced ATA recurrence compared to CA alone, particularly in those with non-paroxysmal AF at baseline or undergoing a repeat ablation. Additionally, VOMEI was linked to significantly higher rates of mitral isthmus block, which may have contributed to the observed outcomes.

摘要

背景

用于治疗心房颤动（AF）的导管消融术（CA）疗效有限。马歇尔静脉（VOM）与自主神经支配有关，在房颤中具有致心律失常作用，可通过乙醇注入进行消融。然而，VOM乙醇注入（VOMEI）对房性快速心律失常（ATA）复发的影响仍不清楚。

方法

我们系统检索了PubMed、Embase和Cochrane数据库，以查找比较AF患者接受CA联合或不联合VOMEI的随机对照试验（RCT）和观察性研究。结局指标为ATA复发和二尖瓣峡部（MI）阻滞率。ATA复发定义为索引手术后发生的房颤、心房扑动或房性心动过速。在将研究限制于持续性房颤患者、接受再次手术的患者和RCT后进行敏感性分析。

结果

该荟萃分析纳入了4项RCT和16项观察性研究，共4732例患者，其中2105例（44%）接受了VOMEI。平均随访时间为12至46.8个月。与单独CA相比，VOMEI与显著更低的ATA复发相关（OR：0.51；95%CI：0.40-0.65；p<0.01），且MI阻滞率显著更高（OR：4.41；95%CI：2.47-7.88；p<0.01）。亚组分析还显示，在基线时为持续性房颤的患者（OR：0.47；95%CI：0.35-0.64；p<0.01）、接受再次手术的患者（OR：0.44；95%CI：0.33-0.61；p<0.01）以及限制于RCT后（OR：0.58；95%CI：0.44-0.76；p<0.01），辅助VOMEI与显著更低的ATA复发相关。