Ethanol infusion into the vein of Marshall reduced atrial tachyarrhythmia recurrence during catheter ablation: A systematic review and meta-analysis

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Raymond Pranata MD, William Kamarullah MD, Giky Karwiky MD, Chaerul Achmad MD, PhD, Mohammad Iqbal MD, PhD
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引用次数: 0

Abstract

Background

Ethanol infusion into the vein of Marshall (EIVoM) may increase mitral isthmus bidirectional block (MIBB) and cause local autonomic denervation that may improve outcome.

Objective

This meta-analysis aimed to investigate whether the addition of EIVoM to atrial fibrillation (AF) ablation led to a better outcome.

Methods

Systematic literature search was performed using PubMed, Scopus, ScienceDirect, and Europe PMC for studies that compared the addition of EIVoM during AF ablation with radiofrequency ablation. The primary outcome was atrial tachyarrhythmia (ATa) recurrence, defined as AF/atrial flutter/atrial tachycardia after the blanking period.

Results

There were 2821 patients from 11 studies, and EIVoM was successful in 77% (95% confidence interval [CI] 62%–92%). ATa recurrence was 27% (95% CI 20%–34%) in the EIVoM group and 42% (95% CI 33%–51%) in ablation-only group. EIVoM reduced ATa recurrence (odds ratio [OR] 0.52; 95% CI 0.36–0.76; P < .001; I2 = 76.92). The rate of MIBB was 85% (95% CI 77%–94%) in the EIVoM group and 73% (95% CI 61%–85%) in the ablation-only group, which was significantly higher (OR 3.87; 95% CI 1.46–10.28; P < .001; I2 = 83.68). The mitral isthmus reconnection rate (OR 0.44; 95% CI 0.15–1.29; P = .14; I2 = 63.6) and repeat procedure rate (OR 0.76; 95% CI 0.53–1.08; P = .12; I2 = 48) were similar; however, a leave-one-out sensitivity analysis showed P < .05 for both. The benefits of EIVoM were not affected by age, left atrial diameter, and left ventricular ejection fraction (P > .05). Age (P = .029) and left atrial diameter (P = .042) were inversely associated with EIVoM benefits in terms of repeat ablation and mitral isthmus reconnection (age; P = .003).

Conclusion

The addition of EIVoM to ablation increased MIBB and reduced ATa recurrence.
将乙醇注入马歇尔静脉可减少导管消融过程中心房快速性心律失常的复发:系统回顾和荟萃分析
背景向马歇尔静脉注入乙醇(EIVoM)可能会增加二尖瓣峡部双向阻滞(MIBB),并引起局部自主神经去神经化,从而改善预后。目的本荟萃分析旨在研究在房颤消融术中加入 EIVoM 是否会带来更好的预后。方法使用PubMed、Scopus、ScienceDirect和Europe PMC对房颤消融过程中添加EIVoM与射频消融进行比较的研究进行系统文献检索。主要结果是房性快速性心律失常(ATa)复发,定义为空白期后的房颤/房扑/房性心动过速。结果11项研究中有2821名患者,EIVoM成功率为77%(95%置信区间[CI] 62%-92%)。EIVoM组的ATA复发率为27%(95%置信区间为20%-34%),单纯消融组为42%(95%置信区间为33%-51%)。EIVoM 降低了 ATa 复发率(几率比 [OR] 0.52;95% CI 0.36-0.76;P < .001;I2 = 76.92)。EIVoM组的MIBB率为85%(95% CI 77%-94%),纯消融组为73%(95% CI 61%-85%),明显高于EIVoM组(OR 3.87; 95% CI 1.46-10.28; P < .001; I2 = 83.68)。二尖瓣峡部再连接率(OR 0.44;95% CI 0.15-1.29;P = .14;I2 = 63.6)和重复手术率(OR 0.76;95% CI 0.53-1.08;P = .12;I2 = 48)相似;但是,留出一例的敏感性分析显示,两者的 P < .05。EIVoM 的益处不受年龄、左心房直径和左心室射血分数的影响(P >.05)。年龄(P = .029)和左房直径(P = .042)与 EIVoM 在重复消融和二尖瓣峡部重新连接(年龄;P = .003)方面的益处成反比。
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来源期刊
Heart Rhythm O2
Heart Rhythm O2 Cardiology and Cardiovascular Medicine
CiteScore
3.30
自引率
0.00%
发文量
0
审稿时长
52 days
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