Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Ablation Techniques D-PO02 - Poster Session II (ID 47) Poster

D-PO02-156 - Impact Of Vein Of Marshall Ethanol Infusion On Endocardial Voltage Mapping In Patients With Persistent Atrial Fibrillation (ID 1036)


Background: An anatomical ablation strategy for persistent AF that incorporates vein of Marshall ethanol infusion (VOMEI) has shown promise (the Marshall-PLAN). However, there are limited data on the impact of this approach on the left atrium voltage
Objective: Using high-density mapping, we sought to evaluate the surface and location of low voltage areas (LVA) induced by ethanol infusion
Methods: Consecutive patients undergoing catheter ablation using the Marshall-PLAN were prospectively enrolled. Endocardial voltage mapping before and after VOMEI was acquired using a multipolar catheter. LVA was defined by a voltage under 0.5 mV
Results: 86 patients were included (62.5 years old, 84% male, CHADS2-VASc 1.9 [1-3], LVEF 56% [50-63]). The maximum AF episode duration was 8.3 [3-12] months and current AF episode was 5.7 [1-7.3] months. 70 patients were on anti-arrhythmic drugs before ablation (65% amiodarone, 11% flecainide, 7% sotalol). 10 patients had undergone previous pulmonary vein isolation. 68 patients had LVA identified before VOMEI (19.1 cm2 [5.2-30.1]), including 40% in the expected VOM area. The mean LVA at baseline in the VOM region was 5,1 cm2 [1.9-8.0], which increased after VOMEI to 13.2 cm2 [7.8-16.2] (p<0.001). LVAs after VOMEI were observed below the left inferior pulmonary vein (71 patients), along the ridge (52), in the mitral isthmus region continuous with the mitral annulus (32), on the posterior wall (18), on the roof (10), and in isolation (3)
Conclusion: VOMEI can serve to target the left atrial myocardium as an adjunct to traditional catheter ablation, most often affecting the area below the left inferior pulmonary vein, along the ridge, and adjacent to the mitral annulus