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Efficacy and safety of ethanol infusion into the vein of Marshall for mitral isthmus ablation
  • +14
  • Anna Lam,
  • Thomas Küffer,
  • Lukas Hunziker,
  • Nikolas Nozica,
  • Babken Asatryan,
  • Florian Franzeck,
  • Antonio Madaffari,
  • Andreas Haeberlin,
  • Aline Mühl,
  • Helge Servatius,
  • Jens Seiler,
  • Fabian Noti,
  • Samuel Baldinger,
  • Hildegard Tanner,
  • Stephan Windecker,
  • Tobias Reichlin,
  • Laurent Roten
Anna Lam
Inselspital University Hospital Bern
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Thomas Küffer
Inselspital University Hospital Bern
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Lukas Hunziker
Inselspital University Hospital Bern
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Nikolas Nozica
Inselspital University Hospital Bern
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Babken Asatryan
Inselspital University Hospital Bern
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Florian Franzeck
Inselspital University Hospital Bern
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Antonio Madaffari
Inselspital University Hospital Bern
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Andreas Haeberlin
Inselspital University Hospital Bern
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Aline Mühl
Inselspital University Hospital Bern
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Helge Servatius
Inselspital University Hospital Bern
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Jens Seiler
Inselspital University Hospital Bern
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Fabian Noti
Inselspital University Hospital Bern
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Samuel Baldinger
Inselspital University Hospital Bern
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Hildegard Tanner
Inselspital University Hospital Bern
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Stephan Windecker
Inselspital University Hospital Bern
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Tobias Reichlin
Inselspital University Hospital Bern
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Laurent Roten
Inselspital University Hospital Bern
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Abstract

Introduction: Chemical ablation by retrograde infusion of ethanol into the vein of Marshall (VOM-EI) can facilitate achievement of mitral isthmus block. This study sought to describe efficacy and safety of this technique. Methods and Results: Twenty-two consecutive patients (14 male, median age 71 years) with attempted VOM-EI for mitral isthmus ablation were included in the study. VOM-EI was successfully performed with a median of 4 ml of 96% ethanol in 19 patients (86%) and mitral isthmus was successfully blocked in all (100%). Touch up endocardial and/or epicardial ablation after VOM-EI was necessary in 12 patients (63%). Perimitral flutter was present in 12 patients (63%) during VOM-EI and terminated or slowed by VOM-EI in four and three patients, respectively. Low-voltage area of the mitral isthmus region increased from 3.1 cm2 (IQR 0-7.9) before to 13.2 cm2 (IQR 8.2-15.0) after VOM-EI and correlated significantly with the volume of ethanol injected (P = 0.03). Median high-sensitive cardiac troponin-T increased significantly from 330 ng/L (IQR 221-516) the evening of the procedure to 598 ng/L (IQR 382-769; P=0.02) the following morning. A small pericardial effusion occurred in three patients (16%), mild pericarditis in one (5%) and uneventful VOM dissection in two (11%). After a median follow-up of 3.5 months (IQR 3.0-11.0), 10 of 18 patients (56%) with VOM-EI and available follow-up had arrhythmia recurrence. Repeat ablation was performed in five patients (50%) and peri-mitral flutter diagnosed in three (60%). Conclusion: VOM-EI is feasible, safe and effective to achieve acute mitral isthmus block

Peer review status:ACCEPTED

15 Feb 2021Submitted to Journal of Cardiovascular Electrophysiology
16 Feb 2021Submission Checks Completed
16 Feb 2021Assigned to Editor
20 Feb 2021Reviewer(s) Assigned
14 Mar 2021Review(s) Completed, Editorial Evaluation Pending
23 Mar 2021Editorial Decision: Revise Minor
27 Mar 20211st Revision Received
05 Apr 2021Submission Checks Completed
05 Apr 2021Assigned to Editor
05 Apr 2021Reviewer(s) Assigned
10 Apr 2021Review(s) Completed, Editorial Evaluation Pending
19 Apr 2021Editorial Decision: Accept