Effectiveness of Ethanol infusion into the vein of Marshall combined
with a fixed anatomical ablation strategy (the ‘upgraded 2C3L’ approach)
for catheter ablation of persistent atrial fibrillation
Abstract
Abstract Introduction: Linear ablation in addition to pulmonary vein
antrum isolation (PVAI) has failed to improve the success rate for
persistent atrial fibrillation (PeAF), due to incomplete block of
ablation lines, especially in the mitral isthmus (MI). Methods and
results: The study enrolled 191 patients (66 in group 1 and 125 in group
2). In group 1, EI-VOM was firstly performed, followed by radiofrequency
(RF) applications targeting bilateral PVAI and bidirectional block in
the roofline, cavotricuspid isthmus, and MI. In group 2, PVAI and the
three linear ablations were completed using only RF energy. MI block was
achieved in 63(95.5%) and 101(80.8%) patients in group 1 and 2,
respectively (p=0.006). Patients in group 1 had shorter ablation time
for left pulmonary vein antrum (8.15 min vs 12.59 min,
p<0.001) and MI (7.0 min vs 11.8 min, p<0.001) and
required less cardioversion (50(78.5%) vs 113(90.4%), p=0.007). During
the 12-month follow-up, 58 (87.9%) patients were free from AF/AT in
group 1 compared with 81 (64.8%) in group 2 (p<0.001). In
multivariate cox regression, the ‘upgraded 2C3L’ procedure is associated
with a lower recurrence rate (HR 0.27, 95%CI 0.12-0.59). Conclusion:
Compared with the conventional ‘2C3L’ approach, the ‘upgraded 2C3L’
approach has higher effectiveness for ablation of PeAF.
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