Arrhythmias & electrophysiology
Mechanisms of Mitral Isthmus Reconnection After Ablation With and Without Vein of Marshall Ethanol Infusion
Authors' conclusion
MI reconnections after RFA are due to epicardial connections from VOM. Recurrences after VOMEI are due to incomplete annular MI RFA and CS arrhythmogenesis including CS-mediated perimitral flutter, CS-to-LA re-entry and CS focal activity.
Study context
- Population
- Patients undergoing Vein of Marshall ethanol infusion (VOMEI) for mitral isthmus ablation
- Participants
- 231 consecutive VOMEI procedures
- Comparison
- Mitral isthmus (MI) reconnection mechanisms with vs without VOMEI
- De novon = 140
- Rescue VOMEIn = 91
- Outcome
- Anatomic substrates of failed MI ablation, with and without VOMEI
Methodological detailsconsecutive procedures
- Consecutive procedures
Main finding
As reported in the abstract
- Recurrence after VOMEI (follow-up 725 ± 455 days)
- 78 (33.7%)
- MI reconnection among recurrences
- 36 (46%)
- Other recurrence mechanisms
- 42
- Block restored by endocardial radiofrequency (RF) at annular MI
- 16 (45%)
- Coronary sinus (CS) RF required
- 20 (55%)
Further findings
Intraprocedural factors associated with MI reconnection
| OR | P value | |
|---|---|---|
| Ethanol volume ≥4 mL | 0.74 | P = NS |
| CS ablation at VOMEI | 4.05 | P = 0.003 |
| Age | 1.06 | P = 0.011 |
Original publication
Mechanisms of Mitral Isthmus Reconnection After Ablation With and Without Vein of Marshall Ethanol Infusion. JACC Clin Electrophysiol. Published 11 September 2024. doi:10.
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