Abstract：
BACKGROUND: While ethanol infusion into the vein of Marshall (VOM) as an adjunct to atrial fibrillation ablation has shown promise, adoption has been limited by the technical expertise required, unclear antiarrhythmic mechanism, and complication risk. Delayed pericardial effusions have been associated with ethanol infusion into the VOM in prior studies. Very little is known about how the procedural approach itself can impact the risk of delayed effusions. We sought to understand the incidence and influence of procedural technique on complications including delayed pericardial effusions from VOM ethanol infusion at a large single medical center.
METHODS: A total of 275 atrial ablation cases wherein VOM ethanol infusion was attempted were identified from the time of the program\'s inception in 2019 at Maine Medical Center (Portland, ME) until October of 2023. Cases were classified into phase I cases (early experience) and phase II cases (later experience) based upon temporal programmatic changes in the ethanol dose and infusion rate as well as the use of routine VOM venography. Procedural details and complications were adjudicated from the medical record.
RESULTS: The overall VOM ethanol infusion success was 91.4%. Nine complications (3.3%) occurred in eight patients (2.9% of patients). These were more frequent in phase I (5.8%) compared to phase II (1.3%, p = 0.047). This difference was driven by a difference in delayed presentations of tamponade, which occurred in four patients in phase I (3.3%) and in no patients in phase II (0%, p = 0.037). Twelve-month estimated atrial arrhythmia freedom did not differ between groups (73.8% phase I vs 70.4% phase II, p = 0.24).
CONCLUSIONS: In our single-center experience, adjustments to the procedural approach with lower ethanol infusion rate and dosage, combined with utilizing selective VOM venography, associated with a lowering of complication rates and in particular, delayed pericardial tamponade.
METHODS: A total of 275 atrial ablation cases wherein VOM ethanol infusion was attempted were identified from the time of the program\'s inception in 2019 at Maine Medical Center (Portland, ME) until October of 2023. Cases were classified into phase I cases (early experience) and phase II cases (later experience) based upon temporal programmatic changes in the ethanol dose and infusion rate as well as the use of routine VOM venography. Procedural details and complications were adjudicated from the medical record.
RESULTS: The overall VOM ethanol infusion success was 91.4%. Nine complications (3.3%) occurred in eight patients (2.9% of patients). These were more frequent in phase I (5.8%) compared to phase II (1.3%, p = 0.047). This difference was driven by a difference in delayed presentations of tamponade, which occurred in four patients in phase I (3.3%) and in no patients in phase II (0%, p = 0.037). Twelve-month estimated atrial arrhythmia freedom did not differ between groups (73.8% phase I vs 70.4% phase II, p = 0.24).
CONCLUSIONS: In our single-center experience, adjustments to the procedural approach with lower ethanol infusion rate and dosage, combined with utilizing selective VOM venography, associated with a lowering of complication rates and in particular, delayed pericardial tamponade.
摘要：
背景：虽然向Marshall静脉输注乙醇（VOM）作为房颤消融的辅助手段已显示出希望，采用受到所需技术专长的限制，抗心律失常机制不明确，和并发症风险。在先前的研究中，延迟的心包积液与将乙醇注入VOM有关。关于程序性方法本身如何影响延迟积液的风险知之甚少。我们试图了解手术技术对并发症的发生率和影响，包括大型单一医疗中心VOM乙醇输注引起的延迟心包积液。
方法：从2019年缅因州医疗中心（波特兰，我）直到2023年10月。根据乙醇剂量和输注速率的时间程序变化以及常规VOM静脉造影的使用，将病例分为I期病例（早期经验）和II期病例（后期经验）。手术细节和并发症从病历中裁定。
结果：总体VOM乙醇输注成功率为91.4%。8例患者（2.9％）发生了9种并发症（3.3％）。这些在第一阶段(5.8%)比第二阶段(1.3%，p=0.047)。这种差异是由填塞延迟呈现的差异驱动的，发生在第一阶段的四名患者（3.3％）和第二阶段的无患者（0％，p=0.037)。12个月估计的房性心律失常自由度在组间没有差异(第一阶段73.8%vs第二阶段70.4%,p=0.24）。
结论：在我们的单中心经验中，用较低的乙醇输注速率和剂量调整程序方法，结合选择性VOM静脉造影，与并发症发生率降低相关，特别是，延迟性心包填塞。
方法：从2019年缅因州医疗中心（波特兰，我）直到2023年10月。根据乙醇剂量和输注速率的时间程序变化以及常规VOM静脉造影的使用，将病例分为I期病例（早期经验）和II期病例（后期经验）。手术细节和并发症从病历中裁定。
结果：总体VOM乙醇输注成功率为91.4%。8例患者（2.9％）发生了9种并发症（3.3％）。这些在第一阶段(5.8%)比第二阶段(1.3%，p=0.047)。这种差异是由填塞延迟呈现的差异驱动的，发生在第一阶段的四名患者（3.3％）和第二阶段的无患者（0％，p=0.037)。12个月估计的房性心律失常自由度在组间没有差异(第一阶段73.8%vs第二阶段70.4%,p=0.24）。
结论：在我们的单中心经验中，用较低的乙醇输注速率和剂量调整程序方法，结合选择性VOM静脉造影，与并发症发生率降低相关，特别是，延迟性心包填塞。
