Arrhythmias & electrophysiology
Prompt Identification of the Location of Gap Conduction in the Mitral Isthmus Following Vein of Marshall Ethanol Infusion and Endocardial Ablation
Authors' conclusion
The characteristics of the electrograms in the CSd could aid in the prompt identification of the gap location(s) in the MI in patients with unblocked MI conduction.
Study context
- Population
- Patients who underwent EI-VOM and mitral isthmus (MI) ablationpatients who underwent EI-VOM and MI ablation
- Participants
- 187 patients
- Outcome
- Unblocked MI following EI-VOM and endocardial linear lesion
Methodological detailsexternal validation cohort
- External validation cohort
Performance
As reported in the abstract
Unblocked MI
43.3%
81/187
Further findings
Double potentials in the CSd during left atrial appendage pacing, among patients with unblocked MI
- Double potentials in the CSd, of those with unblocked MI
- 84.0% (68/81)
- Near-field followed by far-field potential (suggesting epicardial gap), of those with double potentials
- 80.9% (55/68)
- Far-field followed by near-field potential (suggesting endocardial gap), of those with double potentials
- 19.1% (13/68)
- Single potentials in the CSd, of those with unblocked MI
- 16.0%, n=13
- In patients with single potentials, simple activation mapping of the endocardium and CSd revealed the gap location
Intracoronary sinus ablation, among patients with unblocked MI
- Intracoronary sinus ablation necessary
- 77.8% (63/81)
- Ablation sites
- 1.3±1.7
- Ablation time
- 1.1±0.4 minutes
MI block achieved
- MI block
- 95.7% (179/187)
External validation cohort
- Findings confirmed; effectiveness and efficiency of CSd potential-guided gap identification demonstrated
Original publication
Prompt Identification of the Location of Gap Conduction in the Mitral Isthmus Following Vein of Marshall Ethanol Infusion and Endocardial Ablation. Circ Arrhythm Electrophysiol. Published 11 June 2025. doi:10.
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