Real-world outcomes of a combined ablation strategy in patients with atrial fibrillation: Spatio-temporal dispersion-based personalised catheter ablation associated with vein of Marshall ethanol infus
Q Voglimacci, A Lepillier, M S Nguyen-Tu, C Bielmann, A Sans, A El-Benna, S Lotteau, P Milpied, C Bars, J Kalifa, J Seitz, J P AlbenqueAbstract
Background
Targeting spatio-temporal dispersion electrogram in atrial fibrillation (AF) has proven superiority to standard pulmonary vein isolation (PVI) in patients with persistent AF (1). Still, adjunctive vein of Marshall (VOM) ethanol infusion presents with potential advantages.
Purpose
To report real-world outcomes of a combination strategy: tailored spatio-temporal dispersion-based ablation and VOM ethanol infusion.
Methods
COMRADE-AI is an observational, prospective, non-randomized, multicentre study to evaluate the use of real-world artificial intelligence-guided spatiotemporal dispersion ablation. In the present analysis, patients underwent a de novo radiofrequency catheter ablation with the Tailored-AF workflow (PVI, dispersion ablation and linear ablation at the operator’s discretion) in addition to VOM ethanol infusion. Only clinically significant relapses were considered for the analysis.
Results
46 patients were included from two centres in France: mean age 68 ± 6 years, 22% women, 70% hypertension, 23% sleep apnea, 7% prior stroke, 13% cardiomyopathy, BMI: 29.5 ± 3.9 kg/m², CHA2DS2-VASc: 2.6 ± 1.3, LVEF: 53 ± 12%, 91% persistent atrial fibrillation, 50% with EHRA score > III. Successful VOM ethanol infusion was achieved in 44 patients (92%). Among those 44 patients, total procedure time, mapping and ablation times were 126 ± 24 min, 30 ± 12 min and 69 ± 19 min, respectively. Acute AF termination by ablation was achieved in 50% of patients while acute sinus rhythm conversion was obtained by ablation in 48% of patients. During the procedure, 38% of patients were treated for an atrial tachycardia. Three serious adverse events were observed in 3/46 patients (7%). They included two episodes of dyspnea and one pacemaker implantation. Kaplan-Meier estimates of 12-month freedom from any atrial arrhythmia was 92% (95% CI: 83-100).
Conclusion
Combination of a tailored ablation strategy targeting spatio-temporal dispersion with VOM ethanol infusion in a real-world cohort is safe and associated with high rate of freedom from arrythmia recurrence.