Vein of Marshall ethanol infusion improves ablation outcomes in patients with persistent atrial fibrillation

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2 Pub Date : 2025-05-01 DOI:10.1016/j.hroo.2025.01.020

Mohammed Al-Sadawi MB BCH, Rushil N. Shah MBBS, DNB, MHS, Amrish Deshmukh MD, Jackson J. Liang DO, Krit Jongnarangsin MD, Fred Morady MD, Hakan Oral MD, Aman Chugh MD, Michael Ghannam MD

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Abstract

Background

Vein of Marshall ethanol infusion (VoMEI) may improve outcomes among patients with persistent atrial fibrillation (AF) undergoing catheter ablation procedures. Prior investigations used heterogeneous ablation strategies, limiting the understanding of VoMEI utility.

Objective

The study sought to examine the safety and efficacy of a uniform ablation approach utilizing VoMEI compared with patients undergoing pulmonary vein isolation (PVI) only or PVI and posterior wall isolation (PWI).

Methods

Patients undergoing first-time ablation for persistent AF utilizing VoMEI with PVI, PWI, and ablation of induced macro–re-entry arrhythmias were included. Two propensity-matched control groups (PVI only and PVI + PWI) were identified with 2:1 matching. Safety and efficacy rates between the groups were examined.

Results

A total of 155 patients were included (VoMEI, n = 31; PVI, n = 62; PVI + PWI, n = 62), consisting of 98 (63%) males 66 ± 10 years of age, with left atrial diameter 49 ± 7 mm, ejection fraction 50 ± 16%, and follow-up time 3.2 ± 2.2 years, with no demographic differences between the groups (P > .05). The 1-year rate of freedom from atrial arrhythmias after a single procedure was 84%, 67%, and 54% for patients undergoing VoMEI, PVI only, and, PVI + PWI, respectively (log rank P = .021). Patients who underwent VoMEI had improved outcomes compared with patients who did not (hazard ratio 0.32, 95% confidence interval 0.12–0.78, P = .01), with fewer repeat procedures (10% vs 37%, P < .01). Procedure, radiofrequency, and fluoroscopy times were greater in the VoMEI groups (P > .05).

Conclusion

Among patients with persistent AF, an ablation strategy incorporating VoMEI improved long-term ablation outcomes compared with groups of propensity-matched patients undergoing PVI only or PVI + PWI.

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静脉马歇尔乙醇输注改善持续性心房颤动患者消融效果

背景：静脉马歇尔乙醇输注（VoMEI）可能改善持续性心房颤动（AF）患者接受导管消融手术的预后。先前的研究采用异质消融策略，限制了对VoMEI效用的理解。目的：本研究旨在比较使用VoMEI的均匀消融入路与仅进行肺静脉隔离（PVI）或PVI和后壁隔离（PWI）的患者的安全性和有效性。方法采用VoMEI联合PVI、PWI首次消融治疗持续性房颤的患者，以及消融诱发的宏观再入性心律失常的患者。2个倾向匹配对照组（仅PVI组和PVI + PWI组）按2:1匹配。比较两组间的安全性和有效率。结果共纳入155例患者(VoMEI, n = 31；PVI, n = 62；PVI + PWI, n = 62)，男性98例（63%），年龄66±10岁，左房径49±7 mm，射血分数50±16%，随访时间3.2±2.2年，组间无统计学差异(P >；. 05)。单次手术后1年房性心律失常发生率分别为84%、67%和54%，分别为VoMEI、PVI和PVI + PWI患者（log rank P = 0.021）。与未行VoMEI的患者相比，行VoMEI的患者预后改善（风险比0.32,95%可信区间0.12-0.78,P = 0.01），重复手术较少(10% vs 37%, P <；. 01)。VoMEI组的手术次数、射频检查次数和透视次数均大于对照组(P >；. 05)。结论：在持续性房颤患者中，与仅接受PVI或PVI + PWI的倾向匹配患者组相比，合并VoMEI的消融策略改善了长期消融结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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