Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2025
Acute mitral isthmus block in patients undergoing catheter ablation for atrial fibrillation: efficacy and safety of a systematic stepwise approach.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
He Bo, Yu Wenxi, Li Yi, Hu Yingying, Wu Xiaoyan, Zhao Fang, Lessomo Fabrice Yves Ndjana, Yao Shuyuan, Lu Zhibing
Аннотация
BACKGROUND: Mitral isthmus (MI) line ablation is associated with a higher success rate of ablation for atrial fibrillation (AF), but completely blocking the MI is often challenging. The purpose of this study was to assess the effectiveness and safety of a systematic, step-by-step approach for completely blocking the MI in patients with AF undergoing MI line ablation for the first time.
METHODS: A total of 338 consecutive AF patients who underwent MI ablation for the first time were included in the study. MI line ablation was performed in the following sequence: Step 1 involved endocardial linear ablation from the mitral annulus to the left inferior pulmonary vein; Step 2 involved epicardial ablation in the coronary sinus (CS), next to the endocardial ablation line; Step 3 involved epicardial-endocardial insertion site mapping and ablation; Step 4 involved ethanol infusion of the vein of Marshall (EIVOM); and Step 5 involved ablation of the ostium of the VOM, followed by Step 3 if needed. The complete MI block was evaluated using differential pacing maneuvres.
RESULTS: After endocardial linear ablation, 111 patients (32.8%) experienced MI block. Further epicardial ablation in the CS induced MI block in another 89 patients (26.3%). In 42 patients (12.4%), epicardial-endocardial insertion sites were ablated to block the MI. EIVOM was performed in 64 patients (18.9%) to achieve MI block. Ablation at the ostium of the VOM induced MI block in 3 patients, and repeating step 3 induced MI block in 17 patients. The total success rate of MI block was 96.4%. No cardiac tamponade occurred during MI ablation.
CONCLUSIONS: With a systematic stepwise approach, acute bidirectional MI block can be achieved with a high success rate and without severe complications.
METHODS: A total of 338 consecutive AF patients who underwent MI ablation for the first time were included in the study. MI line ablation was performed in the following sequence: Step 1 involved endocardial linear ablation from the mitral annulus to the left inferior pulmonary vein; Step 2 involved epicardial ablation in the coronary sinus (CS), next to the endocardial ablation line; Step 3 involved epicardial-endocardial insertion site mapping and ablation; Step 4 involved ethanol infusion of the vein of Marshall (EIVOM); and Step 5 involved ablation of the ostium of the VOM, followed by Step 3 if needed. The complete MI block was evaluated using differential pacing maneuvres.
RESULTS: After endocardial linear ablation, 111 patients (32.8%) experienced MI block. Further epicardial ablation in the CS induced MI block in another 89 patients (26.3%). In 42 patients (12.4%), epicardial-endocardial insertion sites were ablated to block the MI. EIVOM was performed in 64 patients (18.9%) to achieve MI block. Ablation at the ostium of the VOM induced MI block in 3 patients, and repeating step 3 induced MI block in 17 patients. The total success rate of MI block was 96.4%. No cardiac tamponade occurred during MI ablation.
CONCLUSIONS: With a systematic stepwise approach, acute bidirectional MI block can be achieved with a high success rate and without severe complications.