Long-term ablation outcome in patients receiving Vein of Marshall alcohol ablation versus pulsed-field ablation of the left atrial posterior wall in patients with persistent atrial fibrillation
S Mohanty, A Mayedo, B Macdonald, P G Torlapati, V M La Fazia, C A R O L A Gianni, M Marino, A Al-Ahmad, J D Burkhardt, J Allison, W Bode, G J Gallinghouse, L Di Biase, R Horton, A N D R E A NataleAbstract
Background
Pulmonary vein isolation (PVI) alone is known to be not adequate to achieve long-term sinus rhythm in patients with persistent atrial fibrillation (PerAF). Thus, several adjunctive strategies have been tried.
Purpose
We compared the long-term outcome of PVI + Vein of Marshall alcohol ablation (VoM) vs PVI+ left atrial posterior wall isolation (LAPWI) using pulsed-field energy.
Methods
This prospective study included consecutive PerAF patients receiving PVI+VoM (group 1) that were propensity score-matched (1: 2.5) with consecutive PerAF patients undergoing pulsed-field ablation (PFA) for PVI+ LAPWI (group 2). It was the first ablation procedure for all.
PVI was performed using PFA in both groups. Group 2 received additional PFA-based LAPWI. In group 1, VoM was achieved after cannulating the vein with an angioplasty wire and balloon and delivering 1 cc of 98% ethanol over 2 minutes. VoM ablation was performed prior to catheter ablation.
Patients were monitored quarterly with office visits, 7-day Holter, wearable devices such as Apple watch or Kardia and regular self-pulse-checks.
Results
A total of 84 and 210 matched perAF patients were included in group 1 and 2 respectively. Baseline characteristics of the study population is given in table 1. Patients were followed-up for at least 2 years.
At the end of the follow-up, 41 (48.8%) patients from the VoM group and 142 (67.6%) from the LAPWI group remained arrhythmia-free off-antiarrhythmic drugs (p=0.003) (figure 1).
Multivariable regression analysis demonstrated VoM alcohol ablation to be a predictor of recurrence (OR = 2.190; 95% CI 1.307 – 3.670; p-value = 0.004)
Conclusion
In PerAF patients undergoing their first ablation procedure, PFA-based adjunctive LAPWI was demonstrated to have significantly better long-term outcome compared to the vein of Marshall alcohol ablation.