Adjunctive ablation at the mitral isthmus in patients with left ventricular pacing leads: A retrospective multicenter analysis of safety and feasibility.

BACKGROUND

Vein of Marshall ethanol infusion (VOMEI) has benefit in patients with persistent atrial fibrillation and perimitral atrial flutter, whereas coronary sinus (CS) radiofrequency ablation (RFA) improves mitral isthmus block. Atrial arrhythmias frequently coexist with left ventricular (LV) systolic dysfunction, for which cardiac resynchronization therapy (CRT) may be indicated.

OBJECTIVE

This study aimed to evaluate the safety, feasibility, and outcomes of VOMEI ± CS RFA in patients with CRT METHOD: Coding data were used to identify consecutive patients with CRT who underwent VOMEI ± CS RFA at 2 centers. Controls without CRT who underwent contemporaneous VOMEI ± CS RFA provided comparison. Clinical and procedural characteristics and recurrence within 12 months were recorded for all patients. Lead parameters were compared before and after ablation in patients with CRT, and any lead dysfunction over 43 ± 21 months of follow-up was recorded.

RESULTS

VOMEI was feasible in 94% (94% CRT vs 97% control; P = .92), and CS RFA in 89% (84% vs 93%; P = .71). Complications occurred in 5% (6% vs 3%; P = .54), precluding successful VOMEI without causing patient morbidity. No difference in the need for alternative fluoroscopic projections, balloon-occlusion venography, or mitral isthmus block achievement was seen. No significant change in LV lead parameters was observed, and only 1 case of lead dysfunction was seen (phrenic capture, 2%). Arrhythmia recurrence within 1 year was 42% vs 24%

CONCLUSION

VOMEI and CS RFA are feasible and safe in patients with LV leads. Complications are uncommon and preclude VOMEI without causing patient morbidity when they occur, and the risk of clinically significant lead dysfunction is low.