Determinants of outcome impact of vein of Marshall ethanol infusion when added to catheter ablation of persistent atrial fibrillation: A secondary analysis of the VENUS randomized clinical trial.

Autor:	Lador A; Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas., Peterson LE; Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas., Swarup V; Arizona Heart Rhythm Center, Phoenix, Arizona., Schurmann PA; Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas; Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas., Makkar A; Arizona Heart Rhythm Center, Phoenix, Arizona., Doshi RN; Division of Cardiology, Keck-USC University Hospital, University of Southern California, Los Angeles, California., DeLurgio D; Division of Cardiology, Emory St. Joseph's Hospital, Emory University, Atlanta, Georgia., Athill CA; San Diego Cardiac Center, Sharp Memorial Hospital, San Diego, California., Ellenbogen KA; Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia., Natale A; Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas., Koneru J; Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia., Dave AS; Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas., Giorgberidze I; Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas., Afshar H; Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas., Guthrie ML; Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas., Bunge R; Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas., Morillo CA; Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada., Kleiman NS; Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas., Valderrábano M; Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas. Electronic address: MValderrabano@houstonmethodist.org.
Jazyk:	angličtina
Zdroj:	Heart rhythm [Heart Rhythm] 2021 Jul; Vol. 18 (7), pp. 1045-1054. Date of Electronic Publication: 2021 Jan 19.
DOI:	10.1016/j.hrthm.2021.01.005
Abstrakt:	Background: The Vein of Marshall Ethanol for Untreated Persistent AF (VENUS) trial demonstrated that adding vein of Marshall (VOM) ethanol infusion to catheter ablation (CA) improves ablation outcomes in persistent atrial fibrillation (AF). There was significant heterogeneity in the impact of VOM ethanol infusion on rhythm control. Objective: The purpose of this study was to assess the association between outcomes and (1) achievement of bidirectional perimitral conduction block and (2) procedural volume. Methods: The VENUS trial randomized patients with persistent AF (N = 343) to CA combined with VOM ethanol or CA alone. The primary outcome (freedom from AF or atrial tachycardia [AT] lasting longer than 30 seconds after a single procedure) was analyzed by 2 categories: (1) successful vs no perimitral block and (2) high- (>20 patients enrolled) vs low-volume centers. Results: In patients with perimitral block, the primary outcome was reached 54.3% after VOM-CA and 37% after CA alone (P = .01). Among patients without perimitral block, freedom from AF/AT was 34.0% after VOM-CA and 37.0% after CA (P = .583). In high-volume centers, the primary outcome was reached in 56.4% after VOM-CA and 40.2% after CA (P = .01). In low-volume centers, freedom from AF/AT was 30.77% after VOM-CA and 32.61% after CA (P = .84). In patients with successful perimitral block from high-volume centers, the primary outcome was reached in 59% after VOM-CA and 39.1% after CA (P = .01). Tests for interaction were significant (P = .002 for perimitral block and P = .04 for center volume). Conclusion: Adding VOM ethanol infusion to CA has a greater impact on outcomes when associated with perimitral block and performed in high-volume centers. Perimitral block should be part of the VOM procedure. (Copyright © 2021 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu