Ethanol infusion of the vein of Marshall in catheter ablation of persistent atrial fibrillation in patients with mitral valve replacement

Abstract

Background: The effectiveness of ethanol infusion of the vein of Marshall (EIVOM) for persistent atrial fibrillation (AF) in patients with mitral valve replacement (MVR) remains to be determined.

Objectives: This study investigated the effectiveness and safety of EIVOM in catheter ablation of persistent AF in patients with MVR.

Methods: This is a retrospective case-control study. Patients with persistent AF and MVR who underwent the first-time catheter ablation were divided into the EIVOM group (n = 27) and the control group (n = 33). Bilateral pulmonary vein isolation and linear ablations were performed in both groups. In addition, the EIVOM group received EIVOM. Mitral isthmus (MI) block rate, procedure-related complications, and sinus rhythm maintenance rate were compared between the 2 groups in the intention-to-treat population.

Results: There were no significant differences in baseline characteristics between the 2 groups. Twenty-two patients successfully underwent EIVOM. The MI block rate was significantly higher in the EIVOM group (77.8% vs 51.5%; P = .036). After 13.5 months of follow-up (interquartile range, 7.0-22.2), the sinus rhythm maintenance rate was significantly higher in the EIVOM group than in the control group (63.0% vs 36.4%; P = .032). In the multivariate Cox analysis, EIVOM (hazard ratio 0.35; 95% confidence interval, 0.16-0.78; P = .009) was independently associated with the sinus rhythm maintenance rate. One patient in the EIVOM group experienced a self-resolved pericardial effusion. One patient in the control group experienced a pseudoaneurysm.

Conclusion: EIVOM significantly improved the MI linear block rate and the sinus rhythm maintenance rate in patients with persistent AF and MVR.

Keywords: Ethanol infusion; Mitral isthmus block; Mitral valve replacement; Persistent atrial fibrillation; Vein of Marshall.