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Research conducted across 12 hospitals in China has discovered that combining linear ablation with ethanol infusion via the vein of Marshall (EIVOM) alongside pulmonary vein isolation (PVI) significantly improves sinus rhythm maintenance in patients suffering from persistent atrial fibrillation. Atrial fibrillation (AF) is when the heart's upper chambers beat irregularly and often too fast due to misfiring electrical impulses. This can cause blood clots , stroke, heart failure , and other heart problems.
Treating persistent AF is challenging because standard methods used to break up irregular electrical impulses with scar tissue, like PVI, don't always work well over the long term. EIVOM involves injecting alcohol into a tiny vein on the heart's surface. The alcohol creates a controlled chemical scar, helping to block the abnormal electrical pathways.
With linear ablation, doctors create straight lines of scar tissue in specific areas of the heart, preventing the spread of irregular electrical signals. In the study, "Pulmonary Vein Isolation With Optimized Linear Ablation vs. Pulmonary Vein Isolation Alone for Persistent AF: The PROMPT-AF Randomized Clinical Trial," published in JAMA , a cohort of 498 patients was randomized to undergo PVI alone or PVI plus EIVOM and linear ablation.
Of the 498 randomized patients, 495 were included in the primary analysis. The intervention group received EIVOM first, followed by PVI and linear ablation targeting the left atrial roof, mitral isthmus, and cavotricuspid isthmus. The primary objective focused on maintaining freedom from any documented atrial arrhythmias lasting more than 30 seconds without the use of antiarrhythmic drugs over a 12-month period.
The findings revealed that 70.7% of patients who received the combined treatment were free from irregular heartbeats without needing medication after one year, compared to 61.5% of patients who had only the standard PVI treatment.
This difference yielded a hazard ratio of 0.73, indicating statistical significance. Both groups had similar rates of side effects, although the combined treatment group had slightly more cases of mild heart inflammation that didn't require additional treatment.
The study concluded that adding linear ablation with EIVOM to PVI significantly improves freedom from atrial arrhythmias within 12 months for patients with persistent AF compared to PVI alone. More information: Caihua Sang et al, Pulmonary Vein Isolation With Optimized Linear Ablation vs Pulmonary Vein Isolation Alone for Persistent AF, JAMA (2024). DOI: 10.
1001/jama.2024.24438 © 2024 Science X Network.
