Vein of Marshall Ethanol Infusion for Persistent Atrial Fibrillation

项目摘要：本项目的广泛、长期目标是评估静脉灌注马歇尔（VOM）乙醇加入心房颤动（AF）导管消融的治疗价值。房颤是成人中最常见的持续性心律失常，也是导致中风、残疾和死亡率增加的主要原因。导管切除-肺静脉（PV）心房隔离(PVAI)-可以导致治愈，但最适合阵发性房颤，其中由肺静脉引起的异位搏动被证明是房颤的起始点。PVAI在持续性房颤中的成功率较低，其中心脏自主系统，特别是内在心脏神经节的作用越来越被认识到。将消融病灶扩大到更大的左心房（LA）解剖区域，虽能略微改善预后，但也会导致手术复杂性和持续时间的增加，需要重复手术，以及心房扑动等并发症，特别是缘膜扑动（PMF）。我们开发了一种使用马歇尔静脉（VOM）灌注乙醇对房颤患者心房组织进行快速消融的技术，并显示：1)有效，快速和安全的组织消融邻近LA脊和左下PV的LA组织；2)到达心内神经节的局部LA迷走神经去神经支配；3)消融大部分二尖瓣峡部促进PMF的治疗。我们建议评估添加到常规PVAI中的VOM乙醇产生的结果差异。具体目标是：#1。为了评估添加VOM乙醇输注对持续性房颤重新导管消融手术成功的影响。我们将对首次房颤消融的持续性房颤患者进行随机分组，分别使用标准PVAI和VOM乙醇输注加PVAI （VOM- pv）。# 2。评估VOM乙醇输注对复发性房颤消融失败后再次导管消融的影响。在PVAI失败后接受持续性房颤重复手术的患者将随机接受PVAI或vum - pv作为重复手术。终点包括12-15个月后无症状房颤或心电图房颤。

DESCRIPTION (provided by applicant): Project Abstract The broad, long-term objective of this project is to evaluate the therapeutic value of vein of Marshall (VOM) ethanol infusion when added to catheter ablation of atrial fibrillation (AF). AF is the most common sustained arrhythmia in adults, and it is a leading cause of stroke, disability and increased mortality. Catheter ablatin - pulmonary vein (PV) antral isolation (PVAI)- can lead to cure, but is best suited for paroxysmal AF, in which ectopic beats arising from the pulmonary veins were shown to initiate AF. PVAI success is lower in persistent AF, in which the role of the cardiac autonomic system, particularly the intrinsic cardiac ganglia, is being increasingly recognized. Expanding the ablation lesions to include greater areas the left atrial (LA) anatomy marginally improves outcomes, but also leads to increases in procedural complexity and duration, need of repeat procedures, and complications such as atrial flutters, particularly perimitral flutter (PMF). We have developed a technique to perform rapid ablation of atrial tissues in AF using ethanol infusion in the vein of Marshall (VOM), and have shown: 1) Effective, rapid and safe tissue ablation of LA tissue neighboring the LA ridge and left inferior PV; 2) Regional LA vagal denervation by reaching the intrinsic cardiac ganglia; and 3) Facilitation of cure of PMF by ablating most of the mitral isthmus. We propose to evaluate outcomes differences yielded by VOM ethanol when added to conventional PVAI. The specific aims are: #1.To assess the impact of VOM ethanol infusion in procedure success when added to de novo catheter ablation of persistent AF. We will randomize patients with persistent AF undergoing a first AF ablation to standard PVAI vs a combined VOM ethanol infusion plus PVAI (VOM-PV). #2. To assess the impact of VOM ethanol infusion added to repeat catheter ablation of recurrent AF after a failed ablation. Patients undergoing a repeat procedure for persistent AF after a failed PVAI will be randomized to either PVAI or VOM-PV as their repeat procedure. End points will include freedom from symptomatic or electrocardiographic AF after 12-15 months.