背景:Marshall静脉(VoM)乙醇消融术在持续性房颤(AF)患者中已被证明是有益的;然而,其在重复消融中的作用尚不清楚.我们试图评估在重复手术期间,除了后壁隔离(PWI)外,经验性VoM乙醇消融的益处。
方法:23例患者(年龄67.1+/-7.4,男性74%)在PWI的基础上接受经验性VoM乙醇输注,性别,射血分数,和左心房大小,46例仅接受经验性PWI的患者。研究组中的所有患者在二尖瓣峡部接受额外的消融以完成二尖瓣峡部外侧线。额外的消融基于程序和触发刺激。主要结果是在3个月的消隐期后,根据症状鉴定,无房颤。心电图,可穿戴,或植入式监测器或装置。
结果:研究组的平均BMI较高(35.07+/-8.98vs.30.85+/-5.65,p=0.033)和持续性房颤率(83.0%vs.54.3%,p=0.029)与对照。研究组和对照组的1年无房颤生存率分别为20例(86.96%)和28例(60.1%)(p=0.027)。Cox比例风险回归分析显示研究组房颤复发显著减少(HR0.25,95%CI0.073-0.843,p=0.026)。
结论:在反复导管消融术治疗持续性孤立性肺静脉复发的房颤患者中,添加VoM乙醇输注增加了在12个月时保持无房颤的可能性.
BACKGROUND: Vein of Marshall (VoM) ethanol ablation has a proven benefit in patients with persistent atrial fibrillation (AF) undergoing index procedure; however, its role in repeat ablation is unknown. We sought to evaluate the benefit of empiric VoM ethanol ablation in addition to posterior wall isolation (PWI) during the repeat procedure in patients with durable pulmonary vein (PV) isolation from prior ablation.
METHODS: Twenty-three patients (age 67.1 + / - 7.4, 74% males) who received empiric VoM ethanol infusion in addition to PWI were matched for age, gender, ejection fraction, and left atrial size with forty-six patients receiving empiric PWI alone. All patients in the study group underwent additional ablation on mitral isthmus to complete the lateral mitral isthmus line. Additional ablation was based on program and trigger stimulation. Primary outcome was freedom from AF after a blanking period of 3 months by qualification of symptoms, EKG, wearable, or implantable monitor or device.
RESULTS: The study group had a higher average BMI (35.07 + / - 8.98 vs. 30.85 + / - 5.65, p = 0.033) and rate of persistent AF (83.0% vs. 54.3%, p = 0.029) versus the control. The 1-year AF-free survival for the study and control groups was 20 (86.96%) and 28 (60.1%) patients (p = 0.027). Cox proportional hazard regression analysis showed a significant reduction in AF recurrence in the study group (HR 0.25, 95% CI 0.073-0.843, p = 0.026).
CONCLUSIONS: Among patients undergoing repeat catheter ablation for recurrent AF with durably isolated PVs, the addition of VoM ethanol infusion increased the likelihood of remaining free from AF at 12 months.