IMR Press / RCM / Volume 24 / Issue 10 / DOI: 10.31083/j.rcm2410302
Open Access Original Research
Efficacy of Vein of Marshall Ethanol Infusion Added to Left Atrial Anatomical Ablation for Treatment of Persistent Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy
Tao Luo1,2,3,†Tao Liu1,2,3,†Bo Cui1,2,3Xi Li4Jinlin Zhang4Gang Wu1,2,3,*
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1 Department of Cardiology, Renmin Hospital of Wuhan University, 430060 Wuhan, Hubei, China
2 Cardiovascular Research Institute, Wuhan University, 430060 Wuhan, Hubei, China
3 Hubei Key Laboratory of Cardiology, 430060 Wuhan, Hubei, China
4 Department of Cardiology, Wuhan Asian Heart Hospital, 430060 Wuhan, Hubei, China
*Correspondence: Gangwu@whu.edu.cn (Gang Wu)
These authors contributed equally.
Rev. Cardiovasc. Med. 2023, 24(10), 302; https://doi.org/10.31083/j.rcm2410302
Submitted: 25 April 2023 | Revised: 16 June 2023 | Accepted: 4 July 2023 | Published: 23 October 2023
(This article belongs to the Special Issue Advances in Catheter Ablation of Atrial Fibrillation)
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Background: Radiofrequency catheter ablation (RFCA) has been shown to have low efficacy for the treatment of persistent atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM). We conducted this study to evaluate the benefit of adjunctive vein of Marshall (VOM) ethanol infusion during RFCA for persistent AF (PsAF) in patients with non-obstructive HCM. Methods: This multicenter retrospective observational study included 102 consecutive non-obstructive HCM patients with PsAF who underwent RFCA plus VOM ethanol infusion (VOM-EI) (RFCA + VOM, n = 56) or RFCA alone (RFCA, n = 46) for the first time. The efficacy endpoint was survival without AF or atrial tachycardia (AT) after the blanking period. Results: We completed the VOM-EI in 92.9% (52/56) patients. The left pulmonary vein antrum ablation time (RFCA + VOM: 19.9 ± 6.1 min vs. RFCA: 27.2 ± 9.3 min), mitral isthmus (MI) ablation time (RFCA + VOM: 16.9 ± 3.7 min vs. RFCA: 28.4 ± 7.8 min), and rate of coronary sinus (CS) vein ablation (RFCA + VOM: 57.69% vs. RFCA: 80.43%) were lower but the acute success rate of MI block (RFCA + VOM: 98.1% vs. RFCA: 84.8%) were higher in the RFCA + VOM group than those in the RFCA group (all p < 0.05). After twelve months follow-up, 84.6% of patients (44/52) survived without AF/AT in the RFCA + VOM group, compared to 65.2% of patients (30/46) in the RFCA group (p = 0.03; odds ratio = 2.93, 95% CI: 1.18–7.79). Conclusions: VOM-EI combined with RFCA decreased the recurrence rate of AF/AT at 12 months in HCM patients with PsAF. VOM-EI simplified the ablation of the left pulmonary vein antrum and MI and increased the success rate of MI bidirectional block.

Keywords
catheter ablation
vein of marshall
hypertrophic cardiomyopathy
persistent atrial fibrillation
pulmonary vein isolation
Funding
82270243/National Natural Science Foundation of China
82270365/National Natural Science Foundation of China
Figures
Fig. 1.
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