PO-01-091 VEIN OF MARSHALL ETHANOL ABLATION AND LATERAL MITRAL ISTHMUS LINE TO IMPROVE EFFICACY OF PERSISTENT AF ABLATION

Abstract

The optimal approach to ablation of persistent AF has not been well-established, and current strategies are only modestly successful. To assess the efficacy of additional vein of Marshall (VOM) ethanol ablation and lateral mitral isthmus ablation in addition to standard persistent AF ablation strategies using a stepwise approach. Sixty -Five consecutive patients undergoing ablation for persistent AF were included. . All patients underwent PVI with RF ,left atrial roof ablation with confirmed roof line block, and cavotricuspid isthmus ablation were performed. VOM ethanol ablation with concomitant lateral mitral annular ablation ( from the LA endocardium and Coronary sinus as needed) to achieve block were attempted in all patients. Patients underwent follow-up ambulatory monitoring and in -office and telephonic follow-up in a closed health delivery system for at least 12 months f/u from procedure. A total of 38 of 65 patients had successful Vom ethanol injection. .35 of these patients achieved successful mitral annular block. 27 patients did not receive therapy due to venous collateralization (29)%, inability to cannulate, vessel (29%) VOM not identified (19%) and target vessel dissection or extravasation (23%.) With an average follow up of 12 months, patients with successful VOM ethanol ablation and lateral mitral line had an 82% clinical arrhythmia- free survival. In patients with unsuccessful VOM attempt, the arrhythmia free survival was 58%. All patients were off antiarrhythmic drugs, and had only one procedure. One patient with successful VOM ethanol ablation was readmitted with pericarditis without effusion managed with colchicine. The addition of VOM ethanol ablation and lateral mitral isthmus ablation is associated with an improved arrhythmia-free survival in persistent AF ablation.