EIVM, acute EIVM-induced lesion and associated RF lesions at the
index procedure
Arrhythmias prior to EIVM and procedural characteristics are detailed in
Table 2. VOM was identified and EIVM was achieved in every patient.
After sequential ethanol and contrast-agent injection, an aspect of LA
myography was reached in every patient. In one patient, EIVM initially
failed to reach LA myography, and post-EIVM bipolar voltage mapping
showed no lesion created. After further injections at a more proximal
site, LA myography was reached and a scar was created. In 8 (29%)
patients, EIVM acutely changed the atrial rhythm (AF to PMLAF, n=4;
PMLAF to SR, n=3; PMLAF to roof-dependent flutter, n=1). Each patient
showed an acute EIVM-created lesion. The median area of bipolar voltage
< 0.05 mV in the VOM region was 12.5 cm2(IQR 7.6–15.7) immediately after EIVM as compared with 0
cm2 (0–1.65) before EIVM (p<0.0001) (Figure
1). At the end of the procedure, 14 (58%) patients showed a return to
SR or organization to AT. Bidirectional MI block was obtained in 24
(83%) patients. Two patients had a procedural complication: 1 femoral
pseudo-aneurysm requiring stenting and 1 transient sinus node
dysfunction requiring isoprenaline infusion.