Strategy for repeat procedures in patients with persistent atrial fibrillation: Systematic linear ablation with adjunctive ethanol infusion into the vein of Marshall versus electrophysiology‐guided ablation. (5th April 2022)

• Record Type: Journal Article
• Authors: Nakashima, Takashi; Pambrun, Thomas; Vlachos, Konstantinos; Goujeau, Cyril; André, Clémentine; Krisai, Philipp; Ramirez, F. Daniel; Pintican, Gabriela; Kamakura, Tsukasa; Takagi, Takamitsu; Nakatani, Yosuke; Surget, Elodie; Cheniti, Ghassen; Tixier, Romain; Chauvel, Remi; Duchateau, Josselin; Sacher, Frédéric; Cochet, Hubert; Hocini, Mélèze; Haïssaguerre, Michel; Jaïs, Pierre; Derval, Nicolas
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 33:Number 6(2022)
• Page Start: 1116
• Page End: 1124
• Publication Date: 2022-04-05
• Subjects: atrial fibrillation -- catheter ablation -- ethanol infusion -- recurrence -- vein of Marshall; Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.15472
• Languages: English
• ISSNs: 1045-3873

Abstract

Abstract: Introduction: The optimal strategy after a failed ablation for persistent atrial fibrillation (perAF) is unknown. This study evaluated the value of an anatomically guided strategy using a systematic set of linear lesions with adjunctive ethanol infusion into the vein of Marshall (Et‐VOM) in patients referred for second perAF ablation procedures. Methods and Results: Patients with perAF who underwent a second procedure were grouped according to the two strategies. The first strategy was an anatomically guided approach using systematic linear ablation with adjunctive Et‐VOM, with bidirectional blocks at the posterior mitral isthmus (MI), roof, and cavotricuspid isthmus (CTI) as the procedural endpoint (Group I). The second one was an electrophysiology‐guided strategy, with atrial tachyarrhythmia termination as the procedural endpoint (Group II). Arrhythmia behavior during the procedure guided the ablation strategy. Groups I and II consisted of 96 patients (65 ± 9 years; 71 men) and 102 patients (63 ± 10 years; 83 men), respectively. Baseline characteristics were comparable. In Group I, Et‐VOM was successfully performed in 91/96 (95%), and procedural endpoint (bidirectional block across all three anatomical lines) was achieved in 89/96 (93%). In Group II, procedural endpoint (atrial tachyarrhythmia termination) was achieved in 80/102 (78%). One‐year follow‐up demonstrated Group I (21/96 [22%]) experienced less recurrence compared to Group II (38/102 [37%], Log‐rank p = .01). This was driven by lower AT recurrence in Group I (Group I: 10/96 [10%] vs. Group II: 29/102 [28%]; p = .002). Conclusion: Anatomically guided strategy with adjunctive Et‐VOM is superior to an electrophysiology‐guided strategy for second procedures in patients with perAF at 1‐year follow‐up.