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Background - Achieving bidirectional mitral isthmus (MI) block using radiofrequency catheter ablation (RFCA) alone is challenging, and MI reconnection is common. Adjunctive vein of Marshall (VOM) ethanol infusion (VOM-Et) can facilitate acute MI block. However, little is known regarding its long-term success. This study sought to evaluate the impact of adjunctive VOM-Et on MI block achievement and durability compared to RFCA alone. Methods - Patients undergoing a first attempt of posterior MI ablation were grouped according to their MI block index strategy: adjunctive VOM-Et and RFCA alone. Rates of acute MI block and MI reconnection observed during repeat procedures were compared between the two groups. Results - The VOM-Et group consisted of 152 patients (63.8 ± 9.4 years) undergoing adjunctive VOM-Et for MI block. The RFCA group consisted of 110 patients (60.9 ± 9.2 years) undergoing MI ablation using RFCA alone. Acute MI block was more frequently achieved in the VOM-Et group (98.7% [150/152] vs. 63.6% [70/110]; p < 0.001) with shorter RFCA duration (5.00 [3.00-7.00] vs. 19.0 [13.6-22.0] mins; p < 0.001). Of the 220 patients with MI block achieved during the index procedure, 81 underwent a repeat procedure during follow-up (VOM-Et group: 23.3% [35/150] vs. RFCA group: 65.7% [46/70], respectively; p < 0.001). A significantly greater number of patients exhibited durable MI block in the VOM-Et group (62.9% [22/35] vs. 32.6% [15/46], respectively; p = 0.008). Conclusions - Beyond facilitating acute MI block, VOM-Et is associated with greater lesion durability as evidenced by higher rates of MI block during repeat procedures.
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10.1161/circep.120.008884
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Circulation._Arrhythmia_and_electrophysiology
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Impact of Vein of Marshall Ethanol Infusion on Mitral Isthmus Block: Efficacy and Durability.
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