Electrogram characteristics of the coronary sinus in cases requiring epicardial ablation within the coronary sinus for creating a conduction block at the left lateral mitral isthmus

Enhancing ablation outcomes: vein of Marshall ethanol infusion in persistent atrial fibrillation with severe left atrial enlargement

Background

Left atrial (LA) enlargement is a widely recognized factor that increases the risk of ablation failure in patients with atrial fibrillation (AF). This retrospective, observational study aimed to assess the influence of vein of Marshall (VOM) ethanol infusion (VOM-EI) on persistent atrial fibrillation (PsAF) ablation among patients with severe LA enlargement.

Methods

In this research, 178 patients underwent the VOM-EI followed by the radiofrequency (RF) ablation procedure, which was based on circumferential pulmonary vein antrum (CPVA) ablation and linear ablation of the roof of the LA and the mitral isthmus (MI). In comparison, 83 patients only underwent the RF ablation procedure.

Results

In the VOM + RF ablation group, the duration of left CPVA ablation was shorter compared to the RF ablation group (20.3 ± 8.7 minutes vs. 27.1 ± 8.1 minutes, P < 0.0001). The rate of MI block was higher (94.9% vs. 85.5%, P = 0.01) in the VOM + RF ablation group, with a shorter MI ablation time (23.2 ± 10.8 minutes vs. 30.5 ± 11.8 minutes, P < 0.0001), and a lower need for coronary sinus vein ablation compared to the RF ablation group (64.0% vs. 78.3%, P = 0.02). Throughout the one-year observation period, the VOM + RF ablation group exhibited a notably superior survival rate without recurrence compared to the RF ablation group (78.7% vs. 65.1%, P = 0.02). As compared to the RF ablation group, the VOM + RF ablation group had a lower rate of recurrence with atrial tachycardia (8.4% vs. 19.3%, P = 0.01).

Conclusion

The VOM-EI facilitated the left CPVA and the MI ablation and improved the ablation outcomes in patients with severe LA enlargement for treating PsAF.

Efficacy and safety of the vein of Marshall ethanol infusion with radiofrequency catheter ablation for the treatment of persistent atrial fibrillation in elderly patients

Background

Increasing age is a significant risk factor for atrial fibrillation (AF) recurrence after catheter ablation (CA). We accomplished this study to evaluate the efficacy and safety of the vein of Marshall (VOM) ethanol infusion (VOM-EI) with CA in elderly patients with persistent AF (PsAF).

Methods

This retrospective observational study included 360 consecutive adult patients with PsAF, of which 141 were in the Elder group (age ≥65 years) and 219 were in the Younger group (age <65 years), who underwent the VOM-EI and radiofrequency CA (RFCA) between May 2020 and April 2022. The efficacy endpoint was no recurrence of AF within one year after CA.

Results

The VOM-EI was successfully performed in 90.8% of patients from the Elder and 88.6% from the Younger group. All patients achieved PVI; 97.9% of patients from the Elder and 98.6% from the Younger group reached LA roof block, and 93.6% of patients from the Elder and 95.9% from the Younger group achieved MI block. There was no significant difference in 1-year survival without recurrence of AF between the two groups (83.0% and 84.5%, respectively). The incidence of complications within 30 days after the procedure from the two groups was low and did not differ significantly.

Conclusion

The VOM-EI combined with RFCA proved to be an effective and safe strategy for treating PsAF in elderly and younger patients.

Comparison of the Anterior Septal Line and Mitral Isthmus Line for Perimitral Atrial Flutter Ablation Using Robotic Magnetic Navigation

Background

Perimitral atrial flutter (PMAFL) is one of the most common macro-reentrant left atrial tachycardias. Mitral isthmus (MI) linear ablation is a common strategy for the treatment of PMAFLs, and anterior septum (AS) linear ablation has emerged as a novel ablation approach. We aimed at assessing the effectiveness of AS linear ablation using robotic magnetic navigation for PMAFL ablation.

Methods

In this retrospective study, a total of 36 consecutive patients presented with AFL as the unique arrhythmia or accompanied with atrial fibrillation (AF) who underwent catheter ablation were enrolled. Patients were classified into two groups according to the different ablation strategies, the MI line group (10 patients) and the AS line group (26 patients).

Results

The clinical baseline characteristics of patients in the two groups were nearly identical. There were no significant differences in procedure time (148.7 ± 46.1 vs. 123.2 ± 30.1 min, P=0.058) or radiofrequency ablation time (25.9 ± 11.4 vs. 23.5 ± 12.6 min) between the two groups. Fluoroscopy time was longer in the MI line group (8.0 ± 4.4 vs. 5.1 ± 2.7 min, P=0.024), and the acute success rate was higher in the AS line group versus the MI line group (96.2% vs. 70%, P=0.025). The long-term freedom from arrhythmia survival rate was higher in the AS line group (73%) than in the MI line group (40%) after a mean follow-up time of 37.4 months with a 3-month blanking period (P=0.049).

Conclusions

AS linear ablation is an effective and safe strategy for PMAFL ablation using robotic magnetic navigation.