Importance of the vein of Marshall involvement in mitral isthmus ablation
Importance of the vein of Marshall involvement in mitral isthmus ablation
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DOI：
10.1111/pace.13640
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发表时间：
2019-06-01
影响因子：
1.8
通讯作者：
Takatsuki, Seiji
中科院分区：
文献类型：
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作者：
Fujisawa, Taishi;Kimura, Takehiro;Takatsuki, Seiji
背景经马歇尔静脉心外膜传导(VOM)可绕过二尖瓣峡部(MI)线，使MI消融困难。本研究旨在评估VOM在实现心肌梗死传导阻滞中的作用。方法143例非阵发性心房颤动患者接受了首次MI消融。根据植入VOM的2-Fr电极导管的使用情况，将其分为VOM导向组(n=28)和常规组(n=115)。对急性心肌梗死阻断成功率和消融数据进行评估。当仅在VOM或冠状静脉窦(CS)电极上证实双向传导阻滞时，我们将其定义为假性MI传导阻滞。在VOM导向组，我们确定了完整的MI传导阻滞，并在VOM和CS电极上进行了验证。结果在VOM导引组中，MI消融术中有33.3%的患者出现假闭塞。在射频能量(19 322.6+/-11 352.8 vs 25 389.3+/-19 951.9，P=0.04)的情况下，VOM导引组的心肌梗死消融成功率(96.4%vs 91.3%，P=0.36)相似。值得注意的是，在达到完全心肌梗死阻断后，心房爆发起搏在静脉血栓导引组中诱导了两次周围性扑动，并通过额外的射频应用成功地终止了这些扑动。结论VOM的电传导检测可以明确假性MI传导阻滞的存在。然而，只有在心房程序性刺激诱发周围性房性心动过速后，才能检测到通过MI的慢传导的存在。
Background Epicardiac conduction via the vein of Marshall (VOM) can bypass the mitral isthmus (MI) line, making MI ablation difficult. This study aimed to assess the contribution of the VOM in achieving MI conduction block. Methods This study included 143 consecutive patients with nonparoxysmal atrial fibrillation who underwent initial MI ablation. They were retrospectively classified into two groups, a VOM-guided group (n = 28) and a conventional group (n = 115), according to the use of a 2-Fr electrode catheter inserted in the VOM. The acute success rate of achieving MI block and the ablation data were assessed. When the bidirectional block was verified exclusively in the VOM or coronary sinus (CS) electrodes, we defined it as a pseudo MI block. In the VOM-guided group, we ascertained the complete MI block, verified both in the VOM and CS electrodes. Results In the VOM-guided group, the pseudoblock was observed in 33.3% of the patients during MI ablation. With significantly less radiofrequency energy (19 322.6 +/- 11 352.8 vs 25 389.3 +/- 19 951.9, P = 0.04), we achieved a similar level of success rate in MI ablation in the VOM-guided group (96.4% vs 91.3%, P = 0.36). Notably, after achieving complete MI block, atrial burst pacing induced two perimitral flutters in the VOM-guided group, which were successfully terminated by the additional radiofrequency application. Conclusions Assessment of electrical conduction through the VOM could clarify the existence of a pseudo MI conduction block. However, the existence of a slow conduction through the MI could be detected only after induction of perimitral atrial tachycardia with atrial programmed stimulation.