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Published on: May 26, 2015
Ethanol marshall bundle elimination, pulmonary vein isolation, and linear ablation for atrial fibrillation with or
Hongxu Chen1,2, Huahua Li3, Dan Chen1
1Department of Cardiology, Wuhan Asia Heart Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei, China.
Insights
Ethanol infusion of vein of Marshall (EIVOM) combined with catheter ablation shows comparable success for atrial fibrillation (AF) in heart failure (HF) patients. However, HF patients face increased procedural risks, though long-term recurrence rates are similar.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Atrial fibrillation (AF) is closely linked with heart failure (HF) in clinical practice.
- Current AF ablation techniques, like ethanol infusion of the vein of Marshall (EIVOM), have limitations in HF patients.
Purpose of the Study:
- To evaluate the efficacy and safety of EIVOM combined with catheter ablation in AF patients with and without HF.
- To assess AF recurrence and procedural complications in HF patients undergoing EIVOM.
Main Methods:
- A retrospective observational study involving 362 AF patients (182 with HF, 180 without HF).
- Patients underwent a 4-step ablation including EIVOM, pulmonary vein isolation (PVI), and linear ablation.
- Propensity score matching (PSM) was used to control for selection bias.
Main Results:
- EIVOM success rates were lower in HF patients (86.8%) compared to non-HF patients (93.9%).
- HF patients experienced higher rates of cardiac effusion (44.0%) and two cases of atrial-esophageal fistula.
- After a median 12-month follow-up and PSM, AF recurrence rates were similar between HF and non-HF groups.
Conclusions:
- EIVOM combined with catheter ablation is feasible in AF patients with or without HF, with comparable long-term recurrence rates.
- Peri-procedural safety is a significant concern for HF patients undergoing EIVOM.
- Pre-ablation HF status does not appear to influence long-term AF recurrence after EIVOM.
Background:
In medical practice, atrial fibrillation (AF) is intricately associated with heart failure (HF). Currently, ethanol infusion of vein of Marshall (EIVOM) for AF ablation in HF patients remains significantly limited.
Method:
This was a non-randomized, single-center, retrospective observational study. AF patients received 4-step ablation composed of EIVOM, pulmonary vein isolation (PVI) and linear ablation. The primary composite endpoint was defined as recurrence of atrial tachycardia over 30 s. Propensity score matching (PSM) was performed to reduce selection bias.
Results:
From April 2020 to May 2022, 362 patients were included, comprising of 182 HF patients and 180 non-HF patients. EIVOM success rate was lower in HF patients than non-HF patients (86.8% vs. 93.9%). Cardiac effusion was more common in HF patients (44.0% vs. 37.2%), and 2 cases of atrial-esophageal fistula were observed in the HF group. During a median follow-up of 12 months, no significant difference in the primary endpoint was observed between HF and non-HF group. Different HF subgroups had similar AF recurrence. After PSM, AF recurrence rate remained statistically equivalent between the HF and non-HF groups.
Conclusion:
EVIOM combining catheter ablation can be completed with comparable success rate in AF patients with or without HF. However, peri-procedural safety is a concern for HF patients undergoing EIVOM combing AF catheter ablation. During the follow-up, HF status before ablation is not related with increased AF recurrence.
