scholarly journals Durability of mitral isthmus ablation with and without ethanol infusion in the vein of Marshall

2021 ◽  
Author(s):  
Masayuki Ishimura ◽  
Masashi Yamamoto ◽  
Toshiharu Himi ◽  
Yoshio Kobayashi
Keyword(s):  
Atrial Tachycardia ◽  
Ablation Lesion ◽  
Success Rates ◽  
Ablation Process ◽  
Rf Pulses ◽  
Reconnection Rate ◽  
Ethanol Infusion ◽  
Linear Ablation ◽  
Mitral Isthmus

Background: It is established that ethanol infusion in the vein of Marshall (EIVOM) effectively creates a linear ablation lesion in the mitral isthmus (MI). However, data on the long-term success rates of MI ablation remains limited. Methods and Results: Our cohort consisted of 560 patients with non-paroxysmal atrial fibrillation (AF) who underwent an initial MI ablation. Ablations were performed by only radiofrequency (RF) in 384 patients (RF group) or by RF and EIVOM in 176 patients (EIVOM/RF group). Ethanol of 5 mL was used to perform EIVOM in advance of RF. Following EIVOM, RF pulses were delivered to the lateral MI line. Bidirectional MI block was fully achieved in 353 (first 318, re-do 35) patients of the RF group and 171 (first 128, re-do 43) patients of the EIVOM/RF group (p = 0.09 in the first, 0.10 in the re-do ablation cases). In cases with complete MI line block, recurrent AF or atrial tachycardia (AT) was observed in 130 (37%) patients of the RF group and in 64 (37%) patients of the EIVOM/RF group (log-rank p = 0.12 in the first, 0.30 in the re-do ablation cases). Of the total 194 patients, 112 with drug refractory AF or AT proceeded to the subsequent ablation process. Reconnection of MI block line was observed in 39 (49%) patients in the RF group and 25 (58%) patients in the EIVOM/RF group (p = 0.32). Conclusion: EIVOM effectively ensures MI line block; however, the reconnection rate was similar between the two groups.

P1417Short and long term efficiency of different therapeutic approaches to perimitral atrial flutter

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
P Kupo ◽  
R Pap ◽  
G Bencsik ◽  
L Saghy
Keyword(s):  
Retrospective Study ◽  
Atrial Flutter ◽  
Pulmonary Vein ◽  
Success Rates ◽  
Therapeutic Approaches ◽  
Significant Difference ◽  
Mitral Isthmus ◽  
Short And Long Term ◽  
Left Pulmonary Vein

Abstract Introduction Catheter ablation of perimitral flutter can be challenging, owing to difficult anatomy. The most commonly applied procedure is the creation of a mitral isthmus line (between the lower left pulmonary vein and the mitral anulus) or an anteroseptal line (between the upper right pulmonary vein and the anterior mitral anulus). Purpose Our study aimed to compare the short and long term efficacy of two different ablation methods. Methods In our retrospective study 45 consecutive patients diagnosed with perimitral flutter were included between 2009 and 2018. Results Radiofrequency ablation was performed in 48 cases in 31 patients (mitral isthmus line (n = 25, 52.1%); anteroseptal line (n = 23, 47.9%)). Arrhythmia-termination and sinus rhythm restoration could be achieved in 64.6% of the cases (mitral isthmus line: 16/25 (64.0%), anteroseptal line: 15/23 (65.2%). Comparing two different techniques, there was no significant difference (p = 0.85) in acute success rates. During 24.3 months of follow-up period, in 60.0% of the patients no recurrence occurred. The arrhythmia recurred in 6 cases (40.0%) after anteroseptal line ablation, and in 8 cases (53.3%) after mitral isthmus line ablation. No difference was found in the long term efficiency of two  different ablation techniques (p = 0.211). Conclusion In our retrospective study we found no significant difference in the short and long term efficiency of two different therapeutic approaches to perimitral atrial flutter.

scholarly journals Impact of Vein of Marshall Ethanol Infusion on Mitral Isthmus Block

2020 ◽  
Vol 13 (12) ◽  
Author(s):  
Takashi Nakashima ◽  
Thomas Pambrun ◽  
Konstantinos Vlachos ◽  
Cyril Goujeau ◽  
Clémentine André ◽  
...  
Keyword(s):  
Index Procedure ◽  
Ethanol Infusion ◽  
Number Of Patients ◽  
Mitral Isthmus ◽  
Acute Mi ◽  
Isthmus Block ◽  
The Impact ◽  
Repeat Procedures

Background: Achieving bidirectional mitral isthmus (MI) block using radiofrequency catheter ablation (RFCA) alone is challenging, and MI reconnection is common. Adjunctive vein of Marshall (VOM) ethanol infusion (VOM-Et) can facilitate acute MI block. However, little is known about its long-term success. This study sought to evaluate the impact of adjunctive VOM-Et on MI block achievement and durability compared with RFCA alone. Methods: Patients undergoing the first attempt of posterior MI ablation were grouped according to their MI block index strategy: adjunctive VOM-Et and RFCA alone. Rates of acute MI block and MI reconnection observed during repeat procedures were compared between the 2 groups. Results: The VOM-Et group consisted of 152 patients (63.8±9.4 years) undergoing adjunctive VOM-Et for MI block. The RFCA group consisted of 110 patients (60.9±9.2 years) undergoing MI ablation using RFCA alone. Acute MI block was more frequently achieved in the VOM-Et group (98.7% [150/152] versus 63.6% [70/110]; P <0.001) with shorter RFCA duration (5.00 [3.00–7.00] versus 19.0 [13.6–22.0] minutes; P <0.001). Of the 220 patients with MI block achieved during the index procedure, 81 underwent a repeat procedure during follow-up (VOM-Et group: 23.3% [35/150] versus RFCA group: 65.7% [46/70], respectively; P <0.001). A significantly greater number of patients exhibited durable MI block in the VOM-Et group (62.9% [22/35] versus 32.6% [15/46], respectively; P =0.008). Conclusions: Beyond facilitating acute MI block, VOM-Et is associated with greater lesion durability as evidenced by higher rates of MI block during repeat procedures.

Linear ablation of the mitral isthmus during atrial fibrillation ablation increases the incidence of left atrial tachycardia

Heart Rhythm ◽  
2005 ◽  
Vol 2 (5) ◽  
pp. S16 ◽  
Author(s):  
Jesse S. Sethi ◽  
Bryan T. Piedad ◽  
John R. Bullinga ◽  
Douglas S. Holmes ◽  
Neil E. Bernstein ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Atrial Tachycardia ◽  
Atrial Fibrillation Ablation ◽  
Linear Ablation ◽  
Mitral Isthmus

scholarly journals Durability of Left Atrial Lesions after Ethanol Infusion in the Vein of Marshall

2021 ◽  
Author(s):  
Mikael Laredo ◽  
Virginie Ferchaud ◽  
Olivier Thomas ◽  
Ghassan Moubarak ◽  
Bruno Cauchemez ◽  
...  
Keyword(s):  
Coronary Sinus ◽  
Left Atrial ◽  
Mitral Annulus ◽  
Acute Effect ◽  
High Definition ◽  
Bipolar Voltage ◽  
Ethanol Infusion ◽  
Mitral Isthmus ◽  
Efficacy Profile

Background Ethanol infusion in the vein of Marshall (EIVM) has shown to be effective for treating atrial fibrillation (AF) and perimitral left atrial (LA) flutter (PMLAF). Aims To assess the persistence of LA lesions created by EIVM by electro-anatomical mapping (EAM) at repeated procedure for recurrent atrial tachycardia (AT) or AF. Methods We included consecutive patients who underwent EIVM then repeated CA for recurrent AT or AF with high-definition EAM in a single center. Acute and long term EIVM effect was assessed at the index and redo procedures by comparing the area of bipolar voltage <0.05 mV in the vein of Marshall (VOM) region before, immediately after and late after EIVM. Results 24 consecutive patients (mean age 68.6±6.1 years, 58% men) underwent redo procedure after previous successful EIVM for persistent AF (n=21; 88%) or PMLAF (n=5; 21%). In each case, EIVM had an acute effect, with a post-EIVM scar in the VOM (median 12.4 cm2 [interquartile range (IQR) 7.6–15.7]). Mitral isthmus (MI) bidirectional block was obtained in 20/24 patients (83%). In each patient, the EIVM-related lesion persisted, with a chronic scar in the VOM region (median 13.1 cm2 [IQR 8.1–15.9]). One quarter of patients (5/20) had late MI reconnection, which was located at the mitral annulus edge or in the coronary sinus. Conclusions Atrial lesions created by EIVM are durable, which reinforces the efficacy profile of EIVM. Reconduction sites in the MI are located at the edge of the mitral annulus and in the coronary sinus.

scholarly journals Long-term outcomes of empirical extra-pulmonary vein linear ablation in patients with persistent atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
T Hwang ◽  
M Kim ◽  
H Yu ◽  
T Kim ◽  
J Uhm ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Left Atrial ◽  
Atrial Tachycardia ◽  
De Novo ◽  
Persistent Atrial Fibrillation ◽  
Clinical Recurrence ◽  
Linear Ablation ◽  
Extra Pulmonary

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by grants [HI18C0070] and [HI19C0114] from the Korea Health 21 R&D Project, Ministry of Health and Welfare, and a grant [NRF-2020R1A2B01001695] from the Basic Science Research Program run by the National Research Foundation of Korea (NRF). Background Although extra-pulmonary vein (PV) left atrial (LA) linear ablation has been performed during catheter ablation (CA) of persistent atrial fibrillation (PeAF), the long-term efficacy and safety of this procedure have not yet been verified. Purpose We investigated whether an anterior line (AL) and posterior box ablation (POBA) in addition to circumferential PV isolation (CPVI) improves the rhythm without worsening the LA function in PeAF patients. Methods We retrospectively compared the additional AL + POBA and CPVI alone groups in 604 patients with PeAF who underwent regular rhythm follow-ups (16.9%; males 79.3%, 58.5 ± 10.7 years of age) after propensity score matching. The primary endpoint was AF recurrence after single procedures and secondary endpoints were the cardioversion rate, response to anti arrhythmic drugs, LA changes, and re-conduction rates of the de-novo ablation lesion set. Results After a mean follow-up of 45.2 ± 33.6 months, the clinical recurrence rate did not significantly differ between the two groups (log-rank p = 0.554) despite longer procedure times in the AL + POBA group (p &lt; 0.001). Atrial tachycardia recurrences (p = 0.001) and the cardioversion rates after ablation (p &lt; 0.001) were higher in the AL + POBA group than CPVI group. AL + POBA was associated with better rhythm outcomes in patients with large anterior LA volume indices (p for interaction 0.037) and low mean LAA(left atrial appendage) voltages (p for interaction 0.019). In repeat procedures, the LA pulse pressure elevation was significant after the AL + POBA. Conclusion In patients with PeAF, an AL + POBA in addition to the CPVI did not improve the rhythm outcomes nor influence the long-term safety, and lead to more extended procedures. Procedure outcomes OverallAL + POBACPVIp-value(n = 604)(n = 302)(n = 302)Procedure time, min190.8 ± 62.6226.9 ± 49.4154.6 ± 52.8&lt;0.001Ablation time, sec5079 ± 19566420 ± 13723738± 1475&lt;0.001Overall complications24 (4.0)13 (4.3)11 (3.6)0.835Early recurrence, n (%)277 (45.9)129 (42.7)148 (49.0)0.142Recurrence type AT, n (% in early recur)77 (27.8)51 (39.5)26 (17.6)&lt;0.001Clinical recurrence within 1-year, n(%)116 (19.2)52 (17.2)65 (21.5)0.256Recurrence type AT, n (% in clinical recur)60 (23.1)46 (30.7)14 (12.7)0.001Cardioversion, n (% in total recur/ % overall)105 (40.4/17.4)74 (49.3/24.5)31 (28.1/10.3)&lt;0.001POBA, posterior box ablation; AL, anterior line; CPVI, circumferential pulmonary vein isolation; AT, atrial tachycardia;Abstract Figure. Long term ablation outcome

Electrocardiogram Recognition and Ablation of Atrial Tachycardia

2011 ◽  
Vol 3 (1) ◽  
pp. 80
Author(s):  
Alexander Feldman ◽  
Jonathan M Kalman ◽  
◽  
Keyword(s):  
Catheter Ablation ◽  
Atrial Tachycardia ◽  
Primary Treatment ◽  
P Wave ◽  
Wave Morphology ◽  
Focal Atrial Tachycardia ◽  
Mapping Techniques ◽  
Electrocardiogram Ecg ◽  
Surface Electrocardiogram

Focal atrial tachycardia (AT) is a relatively uncommon cause of supraventricular tachycardia, but when present is frequently difficult to treat medically. Atrial tachycardias tend to originate from anatomically determined atrial sites. The P-wave morphology on surface electrocardiogram (ECG) together with more sophisticated contemporary mapping techniques facilitates precise localisation and ablation of these ectopic foci. Catheter ablation of focal AT is associated with high long-term success and may be viewed as a primary treatment strategy in symptomatic patients.

Two decades of experience on ablation in children with Ebstein’s anomaly

2021 ◽  
pp. 1-7
Author(s):  
Tevfik Karagöz ◽  
İlker Ertuğrul ◽  
Ebru Aypar ◽  
Aydın Adıgüzel ◽  
Hayrettin Hakan Aykan ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
Atrial Tachycardia ◽  
Ebstein’S Anomaly ◽  
Atrioventricular Nodal Reentrant Tachycardia ◽  
Success Rates ◽  
Recurrence Rates ◽  
Ebstein's Anomaly ◽  
Accessory Pathways ◽  
Rare Occasion ◽  
The Right

Abstract Introduction: Accessory pathways are commonly seen due to delamination of tricuspid valve leaflets. In addition to accessory pathways, an enlarged right atrium due to tricuspid regurgitation and incisional scars creates substrates for atrial re-entries and ectopic tachycardia. We sought to describe our experience with catheter ablation in children with Ebstein’s anomaly. Methods and results: During the study period, of 89 patients diagnosed with Ebstein’s anomaly, 26 (30.9%) of them who underwent 33 ablation procedures were included in the study. Accessory pathways were observed in the majority of procedures (n = 27), whereas atrial flutter was observed in five, atrioventricular nodal reentrant tachycardia in five, and atrial tachycardia in two procedures. Accessory pathways were commonly localised in the right posteroseptal (n = 10 patients), right posterolateral (n = 14 patients), septal (n = two patients), and left posteroseptal (n = one patient) areas. Multiple accessory pathways and coexistent arrhythmia were observed in six procedures. All ablation attempts related to the accessory pathways were successful, but recurrence was observed in five (19%) of the ablations. Ablation for atrial flutter was performed in five patients; two of them were ablated successfully. One of the atrial tachycardia cases was ablated successfully. Conclusions: Ablation in patients with Ebstein’s anomaly is challenging, and due to nature of the disease, it is not a rare occasion in this group of patients. Ablation of accessory pathways has high success, but also relatively high recurrence rates, whereas ablation of atrial arrhythmias has lower success rates, especially in operated patients.

scholarly journals The Role of Hydraulic Silicate Cements on Long-Term Properties and Biocompatibility of Partial Pulpotomy in Permanent Teeth

Materials ◽  
2021 ◽  
Vol 14 (2) ◽  
pp. 305
Author(s):  
Chung-Min Kang ◽  
Saemi Seong ◽  
Je Seon Song ◽  
Yooseok Shin
Keyword(s):  
Regression Analysis ◽  
Cox Regression ◽  
Antimicrobial Properties ◽  
Permanent Teeth ◽  
Success Rates ◽  
Pulp Tissue ◽  
Cox Regression Analysis ◽  
Clinical Variables

The use of hydraulic silicate cements (HSCs) for vital pulp therapy has been found to release calcium and hydroxyl ions promoting pulp tissue healing and mineralized tissue formation. The present study investigated whether HSCs such as mineral trioxide aggregate (MTA) affect their biological and antimicrobial properties when used as long-term pulp protection materials. The effect of variables on treatment outcomes of three HSCs (ProRoot MTA, OrthoMTA, and RetroMTA) was evaluated clinically and radiographically over a 48–78 month follow-up period. Survival analysis was performed using Kaplan–Meier survival curves. Fisher’s exact test and Cox regression analysis were used to determine hazard ratios of clinical variables. The overall success rate of MTA partial pulpotomy was 89.3%; Cumulative success rates of the three HSCs were not statistically different when analyzed by Cox proportional hazard regression analysis. None of the investigated clinical variables affected success rates significantly. These HSCs showed favorable biocompatibility and antimicrobial properties in partial pulpotomy of permanent teeth in long-term follow-up, with no statistical differences between clinical factors.

Endovascular Treatment of Iliac Occlusive Disease: Review and Update

Vascular ◽  
2007 ◽  
Vol 15 (1) ◽  
pp. 5-11 ◽  
Author(s):  
Albeir Y. Mousa ◽  
Robert B. Beauford ◽  
Lucio Flores ◽  
Peter L. Faries ◽  
Prem Patel ◽  
...  
Keyword(s):  
Transluminal Angioplasty ◽  
Occlusive Disease ◽  
Success Rates ◽  
Endovascular Interventions ◽  
Late Failure ◽  
Therapeutic Measures ◽  
Comparison Of Techniques ◽  
Open Versus ◽  
Angioplasty And Stenting

Use of endovascular interventions for arterial occlusive lesions continues to increase. With the evolution of the technology supporting these therapeutic measures, the results of these interventions continue to improve. In general, a comparison of techniques for revascularization of iliac occlusive diseases shows similar initial technical success rates for open versus percutaneous transluminal angioplasty. Angioplasty is often associated with lower periprocedural morbidity and mortality rates. Conversely, surgery frequently provides greater long-term patency, although late failure of percutaneous therapies may occur but still can be treated successfully with reintervention. The perpetual buildup of experience with angioplasty and stenting will eventually characterize its role in the management of occlusive disease. This review outlines the current consensus and applicability of endovascular management of iliac occlusive diseases.

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