Clinical Influence of Ethanol Infusion in the Vein of Marshall on Left Atrial Appendage Occlusion: Results of Feasibility and Safety during Implantation and at 60-Day Follow-Up

Abstract

Background: Ethanol infusion in the vein of Marshall (EI-VOM) has the advantages of reducing the burden of atrial fibrillation (AF), decreasing AF recurrence, and facilitating left pulmonary vein isolation and mitral isthmus bidirectional conduction block. Moreover, it can lead to prominent edema of the coumadin ridge and atrial infarction. Whether these lesions will affect the efficacy and safety of left atrial appendage occlusion (LAAO) has not yet been reported. Objectives: To explore the clinical outcome of EI-VOM on LAAO during implantation and after 60 days of follow-up. Methods: A total of 100 consecutive patients who underwent radiofrequency catheter ablation combined with LAAO were enrolled in this study. Patients who also underwent EI-VOM at the same period of LAAO were assigned to group 1 (n = 26), and those who did not undergo EI-VOM were assigned to group 2 (n = 74). The feasibility outcomes included intra-procedural LAAO parameters and follow-up LAAO results involving device-related thrombus, a peri-device leak (PDL), and adequate occlusion (defined as a PDL ≤ 5 mm). Safety outcomes were defined as the composites of severe adverse events and cardiac function. Outpatient follow-up was performed 60 days post-procedure. Results: Intra-procedural LAAO parameters, including the rate of device reselection, rate of device redeployment, rate of intra-procedural PDLs, and total LAAO time, were comparable between groups. Furthermore, intra-procedural adequate occlusion was achieved in all patients. After a median of 68 days, 94 (94.0%) patients received their first radiographic examination. Device-related thrombus was not detected in the follow-up populations. The incidence of follow-up PDLs was similar between the two groups (28.0% vs. 33.3%, p = 0.803). The incidence of adequate occlusion was comparable between groups (96.0% vs. 98.6%, p = 0.463). In group 1, none of the patients experienced severe adverse events. Ethanol infusion significantly reduced the right atrial diameter. Conclusions: The present study showed that undergoing an EI-VOM procedure did not impact the operation or effectiveness of LAAO. Combining EI-VOM with LAAO was safe and effective.

Keywords

• atrial fibrillation
• vein of Marshall
• left atrial appendage occlusion
• peri-device leak
• cardiac computed tomography angiography