Long-term efficacy and safety of adjunctive ethanol infusion into the vein of Marshall during catheter ablation for nonparoxysmal atrial fibrillation

Chih Min Liu, Li Wei Lo, Yenn Jiang Lin, Chin Yu Lin, Shih Lin Chang, Fa Po Chung, Tze Fan Chao, Yu Feng Hu, Ta Chuan Tuan, Jo Nan Liao, Yun Yu Chen, Ling Kuo, Ting Yung Chang, Quang Minh Hoang, Simon Salim, Jennifer Jeanne B. Vicera, Cheng I. Wu, Chieh Mao Chuang, Ting-Chun Huang, Shih Ann Chen

Research output: Contribution to journalArticle

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Abstract

Introduction: We aimed to clarify the effect of vein of Marshall (VOM) ethanol infusion for treating VOM triggers and/or mitral flutter after first-attempt endocardial ablation in patients with nonparoxysmal atrial fibrillation (AF). Methods and Results: Of the 254 consecutive patients (age, 56 ± 10 years; 221 male) undergoing catheter ablation for drug-refractory nonparoxysmal AF, 32 (12.6%) received VOM ethanol infusion. The patients were stratified into group 1 (pulmonary vein isolation [PVI], substrate modification, VOM ethanol infusion), group 2 (PVI, substrate modification), and group 3 (PVI alone). Propensity-matched analysis (N = 128) of long-term outcomes (3.9 ± 0.5 years) revealed a higher AF recurrence risk in group 2 (hazard ratio [HR], 4.17; 95% confidence interval [95% CI], 1.63-10.69; P =.003) and group 3 (HR, 1.82; 95% CI, 1.09-3.04; P =.021) than in group 1, as well as a higher atrial arrhythmia recurrence risk in group 2 than in group 1 (HR, 2.42; 95% CI, 1.16-5.03; P =.018). A higher procedural termination rate was observed in group 1 than groups 2 and 3 (41.7% vs 17.2% vs 18.8%; P =.042). On multivariate analysis, VOM ethanol injection was an independent predictor of freedom from recurrence of AF (HR, 0.20; 95% CI, 0.08-0.52; P =.001) and atrial arrhythmia (HR, 0.35; 95% CI, 0.17-0.74; P =.005), whereas a left atrial diameter >45 mm and hypertension were independent risk factors for recurrence. Periprocedural complications rates were comparable among the groups. Conclusion: Adjunctive VOM ethanol infusion is effective and safe for treating nonparoxysmal AF in patients with VOM triggers and/or refractory mitral flutter, providing good long-term freedom from AF and atrial arrhythmia.

Original languageEnglish
Pages (from-to)1215-1228
Number of pages14
JournalJournal of Cardiovascular Electrophysiology
Volume30
Issue number8
DOIs
Publication statusPublished - 2019 Jan 1

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Catheter Ablation
Atrial Fibrillation
Veins
Ethanol
Safety
Confidence Intervals
Pulmonary Veins
Cardiac Arrhythmias
Recurrence
carbosulfan
Multivariate Analysis
Hypertension
Injections
Pharmaceutical Preparations

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Liu, Chih Min ; Lo, Li Wei ; Lin, Yenn Jiang ; Lin, Chin Yu ; Chang, Shih Lin ; Chung, Fa Po ; Chao, Tze Fan ; Hu, Yu Feng ; Tuan, Ta Chuan ; Liao, Jo Nan ; Chen, Yun Yu ; Kuo, Ling ; Chang, Ting Yung ; Hoang, Quang Minh ; Salim, Simon ; Vicera, Jennifer Jeanne B. ; Wu, Cheng I. ; Chuang, Chieh Mao ; Huang, Ting-Chun ; Chen, Shih Ann. / Long-term efficacy and safety of adjunctive ethanol infusion into the vein of Marshall during catheter ablation for nonparoxysmal atrial fibrillation. In: Journal of Cardiovascular Electrophysiology. 2019 ; Vol. 30, No. 8. pp. 1215-1228.
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title = "Long-term efficacy and safety of adjunctive ethanol infusion into the vein of Marshall during catheter ablation for nonparoxysmal atrial fibrillation",
abstract = "Introduction: We aimed to clarify the effect of vein of Marshall (VOM) ethanol infusion for treating VOM triggers and/or mitral flutter after first-attempt endocardial ablation in patients with nonparoxysmal atrial fibrillation (AF). Methods and Results: Of the 254 consecutive patients (age, 56 ± 10 years; 221 male) undergoing catheter ablation for drug-refractory nonparoxysmal AF, 32 (12.6{\%}) received VOM ethanol infusion. The patients were stratified into group 1 (pulmonary vein isolation [PVI], substrate modification, VOM ethanol infusion), group 2 (PVI, substrate modification), and group 3 (PVI alone). Propensity-matched analysis (N = 128) of long-term outcomes (3.9 ± 0.5 years) revealed a higher AF recurrence risk in group 2 (hazard ratio [HR], 4.17; 95{\%} confidence interval [95{\%} CI], 1.63-10.69; P =.003) and group 3 (HR, 1.82; 95{\%} CI, 1.09-3.04; P =.021) than in group 1, as well as a higher atrial arrhythmia recurrence risk in group 2 than in group 1 (HR, 2.42; 95{\%} CI, 1.16-5.03; P =.018). A higher procedural termination rate was observed in group 1 than groups 2 and 3 (41.7{\%} vs 17.2{\%} vs 18.8{\%}; P =.042). On multivariate analysis, VOM ethanol injection was an independent predictor of freedom from recurrence of AF (HR, 0.20; 95{\%} CI, 0.08-0.52; P =.001) and atrial arrhythmia (HR, 0.35; 95{\%} CI, 0.17-0.74; P =.005), whereas a left atrial diameter >45 mm and hypertension were independent risk factors for recurrence. Periprocedural complications rates were comparable among the groups. Conclusion: Adjunctive VOM ethanol infusion is effective and safe for treating nonparoxysmal AF in patients with VOM triggers and/or refractory mitral flutter, providing good long-term freedom from AF and atrial arrhythmia.",
author = "Liu, {Chih Min} and Lo, {Li Wei} and Lin, {Yenn Jiang} and Lin, {Chin Yu} and Chang, {Shih Lin} and Chung, {Fa Po} and Chao, {Tze Fan} and Hu, {Yu Feng} and Tuan, {Ta Chuan} and Liao, {Jo Nan} and Chen, {Yun Yu} and Ling Kuo and Chang, {Ting Yung} and Hoang, {Quang Minh} and Simon Salim and Vicera, {Jennifer Jeanne B.} and Wu, {Cheng I.} and Chuang, {Chieh Mao} and Ting-Chun Huang and Chen, {Shih Ann}",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/jce.13969",
language = "English",
volume = "30",
pages = "1215--1228",
journal = "Journal of Cardiovascular Electrophysiology",
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Liu, CM, Lo, LW, Lin, YJ, Lin, CY, Chang, SL, Chung, FP, Chao, TF, Hu, YF, Tuan, TC, Liao, JN, Chen, YY, Kuo, L, Chang, TY, Hoang, QM, Salim, S, Vicera, JJB, Wu, CI, Chuang, CM, Huang, T-C & Chen, SA 2019, 'Long-term efficacy and safety of adjunctive ethanol infusion into the vein of Marshall during catheter ablation for nonparoxysmal atrial fibrillation', Journal of Cardiovascular Electrophysiology, vol. 30, no. 8, pp. 1215-1228. https://doi.org/10.1111/jce.13969

Long-term efficacy and safety of adjunctive ethanol infusion into the vein of Marshall during catheter ablation for nonparoxysmal atrial fibrillation. / Liu, Chih Min; Lo, Li Wei; Lin, Yenn Jiang; Lin, Chin Yu; Chang, Shih Lin; Chung, Fa Po; Chao, Tze Fan; Hu, Yu Feng; Tuan, Ta Chuan; Liao, Jo Nan; Chen, Yun Yu; Kuo, Ling; Chang, Ting Yung; Hoang, Quang Minh; Salim, Simon; Vicera, Jennifer Jeanne B.; Wu, Cheng I.; Chuang, Chieh Mao; Huang, Ting-Chun; Chen, Shih Ann.

In: Journal of Cardiovascular Electrophysiology, Vol. 30, No. 8, 01.01.2019, p. 1215-1228.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Long-term efficacy and safety of adjunctive ethanol infusion into the vein of Marshall during catheter ablation for nonparoxysmal atrial fibrillation

AU - Liu, Chih Min

AU - Lo, Li Wei

AU - Lin, Yenn Jiang

AU - Lin, Chin Yu

AU - Chang, Shih Lin

AU - Chung, Fa Po

AU - Chao, Tze Fan

AU - Hu, Yu Feng

AU - Tuan, Ta Chuan

AU - Liao, Jo Nan

AU - Chen, Yun Yu

AU - Kuo, Ling

AU - Chang, Ting Yung

AU - Hoang, Quang Minh

AU - Salim, Simon

AU - Vicera, Jennifer Jeanne B.

AU - Wu, Cheng I.

AU - Chuang, Chieh Mao

AU - Huang, Ting-Chun

AU - Chen, Shih Ann

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: We aimed to clarify the effect of vein of Marshall (VOM) ethanol infusion for treating VOM triggers and/or mitral flutter after first-attempt endocardial ablation in patients with nonparoxysmal atrial fibrillation (AF). Methods and Results: Of the 254 consecutive patients (age, 56 ± 10 years; 221 male) undergoing catheter ablation for drug-refractory nonparoxysmal AF, 32 (12.6%) received VOM ethanol infusion. The patients were stratified into group 1 (pulmonary vein isolation [PVI], substrate modification, VOM ethanol infusion), group 2 (PVI, substrate modification), and group 3 (PVI alone). Propensity-matched analysis (N = 128) of long-term outcomes (3.9 ± 0.5 years) revealed a higher AF recurrence risk in group 2 (hazard ratio [HR], 4.17; 95% confidence interval [95% CI], 1.63-10.69; P =.003) and group 3 (HR, 1.82; 95% CI, 1.09-3.04; P =.021) than in group 1, as well as a higher atrial arrhythmia recurrence risk in group 2 than in group 1 (HR, 2.42; 95% CI, 1.16-5.03; P =.018). A higher procedural termination rate was observed in group 1 than groups 2 and 3 (41.7% vs 17.2% vs 18.8%; P =.042). On multivariate analysis, VOM ethanol injection was an independent predictor of freedom from recurrence of AF (HR, 0.20; 95% CI, 0.08-0.52; P =.001) and atrial arrhythmia (HR, 0.35; 95% CI, 0.17-0.74; P =.005), whereas a left atrial diameter >45 mm and hypertension were independent risk factors for recurrence. Periprocedural complications rates were comparable among the groups. Conclusion: Adjunctive VOM ethanol infusion is effective and safe for treating nonparoxysmal AF in patients with VOM triggers and/or refractory mitral flutter, providing good long-term freedom from AF and atrial arrhythmia.

AB - Introduction: We aimed to clarify the effect of vein of Marshall (VOM) ethanol infusion for treating VOM triggers and/or mitral flutter after first-attempt endocardial ablation in patients with nonparoxysmal atrial fibrillation (AF). Methods and Results: Of the 254 consecutive patients (age, 56 ± 10 years; 221 male) undergoing catheter ablation for drug-refractory nonparoxysmal AF, 32 (12.6%) received VOM ethanol infusion. The patients were stratified into group 1 (pulmonary vein isolation [PVI], substrate modification, VOM ethanol infusion), group 2 (PVI, substrate modification), and group 3 (PVI alone). Propensity-matched analysis (N = 128) of long-term outcomes (3.9 ± 0.5 years) revealed a higher AF recurrence risk in group 2 (hazard ratio [HR], 4.17; 95% confidence interval [95% CI], 1.63-10.69; P =.003) and group 3 (HR, 1.82; 95% CI, 1.09-3.04; P =.021) than in group 1, as well as a higher atrial arrhythmia recurrence risk in group 2 than in group 1 (HR, 2.42; 95% CI, 1.16-5.03; P =.018). A higher procedural termination rate was observed in group 1 than groups 2 and 3 (41.7% vs 17.2% vs 18.8%; P =.042). On multivariate analysis, VOM ethanol injection was an independent predictor of freedom from recurrence of AF (HR, 0.20; 95% CI, 0.08-0.52; P =.001) and atrial arrhythmia (HR, 0.35; 95% CI, 0.17-0.74; P =.005), whereas a left atrial diameter >45 mm and hypertension were independent risk factors for recurrence. Periprocedural complications rates were comparable among the groups. Conclusion: Adjunctive VOM ethanol infusion is effective and safe for treating nonparoxysmal AF in patients with VOM triggers and/or refractory mitral flutter, providing good long-term freedom from AF and atrial arrhythmia.

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