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Effectiveness of Ethanol infusion into the vein of Marshall combined with a fixed anatomical ablation strategy (the ‘upgraded 2C3L’ approach) for catheter ablation of persistent atrial fibrillation
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  • Yi-wei Lai,
  • Xiaoxia Liu,
  • Caihua Sang,
  • Deyong Long,
  • Mengmeng Li,
  • Weili Ge,
  • Xiangfei Liu,
  • Zhibing Lu,
  • Qi Guo,
  • Chao Jiang,
  • Song Zuo,
  • Chen-Xi Jiang,
  • Rong Bai,
  • Ribo Tang,
  • Xue-Yuan Guo,
  • Li Song-Nan,
  • Nian Liu,
  • Wei Wang,
  • Xin Zhao,
  • Changyi Li,
  • Xin Du,
  • Jian zeng Dong,
  • Chang Sheng Ma
Yi-wei Lai
Capital Medical University Affiliated Anzhen Hospital
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Xiaoxia Liu
Harbin Medical University Fourth Hospital
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Caihua Sang
Capital Medical University
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Deyong Long
Capital Medical University
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Mengmeng Li
Capital Medical University Affiliated Anzhen Hospital
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Weili Ge
Taizhou Hospital of Zhejiang Province
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Xiangfei Liu
Shengli oilfield Central Hospital
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Zhibing Lu
Wuhan university
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Qi Guo
Capital Medical University Affiliated Anzhen Hospital
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Chao Jiang
Beijing An Zhen Hospital
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Song Zuo
Capital Medical University Affiliated Anzhen Hospital
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Chen-Xi Jiang
Beijing An Zhen Hospital, Capital Medical University
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Rong Bai
Beijing An Zhen Hospital
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Ribo Tang
Capital Medical University
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Xue-Yuan Guo
Beijing An Zhen Hospital, Capital Medical University
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Li Song-Nan
Beijing Anzhen Hospital,Capital Medical University
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Nian Liu
Capital University of Medical Sciences
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Wei Wang
Beijing An Zhen Hospital
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Xin Zhao
Beijing An Zhen Hospital
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Changyi Li
Capital Medical University Affiliated Anzhen Hospital
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Xin Du
Beijing An Zhen Hospital, Capital Medical University
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Jian zeng Dong
Beijing Anzhen Hospital Capital Medical University
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Chang Sheng Ma
Beijing An Zhen Hospital
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Abstract

Abstract Introduction: Linear ablation in addition to pulmonary vein antrum isolation (PVAI) has failed to improve the success rate for persistent atrial fibrillation (PeAF), due to incomplete block of ablation lines, especially in the mitral isthmus (MI). Methods and results: The study enrolled 191 patients (66 in group 1 and 125 in group 2). In group 1, EI-VOM was firstly performed, followed by radiofrequency (RF) applications targeting bilateral PVAI and bidirectional block in the roofline, cavotricuspid isthmus, and MI. In group 2, PVAI and the three linear ablations were completed using only RF energy. MI block was achieved in 63(95.5%) and 101(80.8%) patients in group 1 and 2, respectively (p=0.006). Patients in group 1 had shorter ablation time for left pulmonary vein antrum (8.15 min vs 12.59 min, p<0.001) and MI (7.0 min vs 11.8 min, p<0.001) and required less cardioversion (50(78.5%) vs 113(90.4%), p=0.007). During the 12-month follow-up, 58 (87.9%) patients were free from AF/AT in group 1 compared with 81 (64.8%) in group 2 (p<0.001). In multivariate cox regression, the ‘upgraded 2C3L’ procedure is associated with a lower recurrence rate (HR 0.27, 95%CI 0.12-0.59). Conclusion: Compared with the conventional ‘2C3L’ approach, the ‘upgraded 2C3L’ approach has higher effectiveness for ablation of PeAF.

Peer review status:ACCEPTED

20 Mar 2021Submitted to Journal of Cardiovascular Electrophysiology
23 Mar 2021Submission Checks Completed
23 Mar 2021Assigned to Editor
27 Mar 2021Reviewer(s) Assigned
10 Apr 2021Review(s) Completed, Editorial Evaluation Pending
19 Apr 2021Editorial Decision: Revise Minor
02 May 20211st Revision Received
04 May 2021Assigned to Editor
04 May 2021Submission Checks Completed
05 May 2021Reviewer(s) Assigned
07 May 2021Review(s) Completed, Editorial Evaluation Pending
10 May 2021Editorial Decision: Revise Minor
14 May 20212nd Revision Received
17 May 2021Submission Checks Completed
17 May 2021Assigned to Editor
17 May 2021Reviewer(s) Assigned
17 May 2021Review(s) Completed, Editorial Evaluation Pending
17 May 2021Editorial Decision: Accept