Impact of Vein of Marshall Ethanol Infusion Combined with Anatomical Ablation for the Treatment of Persistent Atrial Fibrillation: A Long-Term Follow-Up Based on Implantable Loop Recorders

• Published in: Journal of clinical medicine Vol. 12; no. 21; p. 6916
• Main Authors: Nesti, Martina, Luca, Fabiana, Panchetti, Luca, Garibaldi, Silvia, Startari, Umberto, Mirizzi, Gianluca, Landra, Federico, Giannoni, Alberto, Piacenti, Marcello, Rossi, Andrea
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 01.11.2023
• Subjects: Ablation; Alcohol; Anti-arrhythmia drugs; Atrial fibrillation; Cardiac arrhythmia; Care and treatment; catheter ablation (CA); Catheters; Clinical medicine; Diagnosis; Dosage and administration; Ethanol; left atrial (LA) roofline; Pericarditis; persistent atrial fibrillation (PeAF); pulmonary vein isolation (PVI); vein of Marshall (VOM); Veins & arteries; VOM ethanol infusion (EI); Italy; United States > US
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm12216916

Background: The best ablation treatment for persistent atrial fibrillation (PeAF) patients is still debated. The vein of Marshall (VOM) seems to be a promising target for ablation and could be combined with a linear set of ablation lesions. The aim of our study is to evaluate the incidence of AF recurrences in a PeAF population treated with a comprehensive ablation approach consisting of VOM ethanol infusion (EI), pulmonary vein isolation (PVI), a left atrial (LA) roofline, a mitral line (guided by the newly formed lesion after alcohol infusion into the VOM and validated by pacing), and a cavotricuspid isthmus line. Methods: Consecutive patients undergoing the first ablation procedure of catheter ablation (CA) for PeAF were enrolled. All patients underwent VOM-EI, PVI, and ablation lines along the roof of the LA, mitral, and cavotricuspid isthmus. LA voltage mapping before and after VOM-EI was also performed. An implantable loop recorder (ILR) was implanted at the end of the ablation in each patient. Results: Thirty-one consecutive patients (66 ± 8 years and 71% male) affected by PeAF were included in this study. The VOM-EI procedural phase lasted 21.4 ± 10.1 min. PV isolation and lines were validated in all subjects. The ML block was achieved within 10.8 ± 8.7 min. At a mean follow-up of 12 ± 7 months, 27 out of 31 (87%) patients remained free from AT/AF recurrences. Among the patients with recurrences, two (50%) had incomplete ablation lesions and three (75%) had “suboptimal” VOM-EI. In 23/31 patients (74%), antiarrhythmic drugs (AADs) were discontinued after 1 month of follow-up. No significant complications were reported during the follow-up. Conclusions: this single-center experience demonstrates that VOM-EI systematically combined with an anatomical ablation set in patients with PeAF resulted in feasible, safe, and effective freedom from AF/AT recurrences in 87% of the population after a 1-year follow-up period according to an ILR.