Acute and mid-term outcome of ethanol infusion of vein of Marshall for the treatment of perimitral flutter.

Takigawa, Masateru; Vlachos, Konstantinos; Martin, Claire A; Bourier, Felix; Denis, Arnaud; Kitamura, Takeshi; Cheniti, Ghassen; Lam, Anna; Martin, Ruairidh; Frontera, Antonio; Thompson, Nathaniel; Massoullié, Grégoire; Wolf, Michael; Escande, William; André, Clémentine; Zeng, Li-Jun; Nakatani, Yosuke; Nakashima, Takashi; Pillois, Xavier; Ramirez, Daniel; Duchateau, Josselin; Pambrun, Thomas; Sacher, Frederic; Cochet, Hubert; Hocini, Mélèze; Haïssaguerre, Michel; Jaïs, Pierre; Derval, Nicolas

doi:10.1093/europace/euaa137

journal article

Titel:: Acute and mid-term outcome of ethanol infusion of vein of Marshall for the treatment of perimitral flutter.
Dokumenttyp:: Article; Journal Article; Research Support, Non-U.S. Gov't
Autor(en):: Takigawa, Masateru; Vlachos, Konstantinos; Martin, Claire A; Bourier, Felix; Denis, Arnaud; Kitamura, Takeshi; Cheniti, Ghassen; Lam, Anna; Martin, Ruairidh; Frontera, Antonio; Thompson, Nathaniel; Massoullié, Grégoire; Wolf, Michael; Escande, William; André, Clémentine; Zeng, Li-Jun; Nakatani, Yosuke; Nakashima, Takashi; Pillois, Xavier; Ramirez, Daniel; Duchateau, Josselin; Pambrun, Thomas; Sacher, Frederic; Cochet, Hubert; Hocini, Mélèze; Haïssaguerre, Michel; Jaïs, Pierre; Derval, Nicolas
Abstract:: AIMS: We hypothesized that an epicardial approach using ethanol infusion in the vein of Marshall (EIVOM) may improve the result of ablation for perimitral flutter (PMF). METHODS AND RESULTS: We studied 103 consecutive patients with PMF undergoing high-resolution mapping. The first 71 were treated with radiofrequency (RF) ablation alone (RF-group), and the next 32 underwent EIVOM followed by RF on the endocardial and epicardial mitral isthmus (EIVOM/RF-group). Contact force was not measured during ablation. Acute and 1-year outcomes were compared. Flutter termination rates were similar between the RF-group (63/71, 88.7%) and EIVOM/RF-group (31/32, 96.8%, P = 0.27). Atrial tachycardia (AT) terminated with EIVOM alone in 22/32 (68.6%) in the EIVOM/RF-group. Bidirectional block of mitral isthmus was always achieved in the EIVOM/RF-group, but significantly less frequently achieved in the RF-group (62/71, 87.3%; P = 0.05). Median RF duration for AT termination/conversion was shorter [0 (0-6) s in the EIVOM/RF-group than 312 (55-610) s in the RF-group, P < 0.0001], as well as for mitral isthmus block in the EIVOM/RF-group [246 (0-663) s] than in the RF-group [900 (525-1310) s, P < 0.0001]. Pericardial effusion was observed in 1/32 (3.2%) in EIVOM/RF-group and 5/71 (7.0%) in RF-group (P = 0.66); two in RF-group required drainage and one of them developed subsequent ischaemic stroke. One-year follow-up demonstrated fewer recurrences in the EIVOM/RF-group [6/32 (18.8%)] than in the RF-group [29/71 (40.8%), P = 0.04]. By multivariate analysis, only EIVOM was significantly associated with less AT recurrence (hazard ratio = 0.35, P = 0.018). CONCLUSION: Ethanol infusion in the vein of Marshall may reduce RF duration required for PMF termination as well as for mitral isthmus block without severe complications, and the mid-term outcome may be improved by this approach.
Zeitschriftentitel:: Europace
Jahr:: 2020
Band / Volume:: 22
Heft / Issue:: 8
Seitenangaben Beitrag:: 1252-1260
Volltext / DOI:: doi:10.1093/europace/euaa137
PubMed:: http://view.ncbi.nlm.nih.gov/pubmed/32594180
Print-ISSN:: 1099-5129
TUM Einrichtung:: Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (Prof. Schunkert)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert)2020