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SHR Neuro Cancer Cardio Lipid Metab Microb

Hocini, M; Shah, AJ; Nault, I; Rivard, L; Linton, N; Narayan, S; Myiazaki, S; Jadidi, AS; Knecht, S; Scherr, D; Wilton, SB; Roten, L; Pascale, P; Pedersen, M; Derval, N; Sacher, F; Jaïs, P; Clémenty, J; Haïssaguerre, M.
Mitral isthmus ablation with and without temporary spot occlusion of the coronary sinus: a randomized clinical comparison of acute outcomes.
J Cardiovasc Electrophysiol. 2012; 23(5):489-496 Doi: 10.1111/j.1540-8167.2011.02248.x [OPEN ACCESS]
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Co-authors Med Uni Graz: Scherr Daniel
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Abstract:: To evaluate the safety and outcomes of mitral isthmus (MI) linear ablation with temporary spot occlusion of the coronary sinus (CS). CS blood flow cools local tissue precluding transmurality and bidirectional block across MI lesion. In a randomized, controlled trial (CS-occlusion = 20, Control = 22), MI ablation was performed during continuous CS pacing to monitor the moment of block. CS was occluded at the ablation site using 1 cm spherical balloon, Swan-Ganz catheter with angiographic confirmation. Ablation was started at posterior mitral annulus and continued up to left inferior pulmonary vein (LIPV) ostium using an irrigated-tip catheter. If block was achieved, balloon was deflated and linear block confirmed. If not, additional ablation was performed epicardially (power ≤25 W). Ablation was abandoned after ∼30 minutes, if block was not achieved. CS occlusion (mean duration -27 ± 9 minutes) was achieved in all cases. Complete MI block was achieved in 13/20 (65%) and 15/22 (68%) patients in the CS-occlusion and control arms, respectively, P = 0.76. Block was achieved with significantly small number (0.5 ± 0.8 vs 1.9 ± 1.1, P = 0.0008) and duration (1.2 ± 1.7 vs 4.2 ± 3.5 minutes, P = 0.009) of epicardial radiofrequency (RF) applications and significantly lower amount of epicardial energy (1.3 ± 2.4 vs 6.3 ± 5.7 kJ, P = 0.006) in the CS-occlusion versus control arm, respectively. There was no difference in total RF (22 ± 9 vs 23 ± 11 minutes, P = 0.76), procedural (36 ± 16 vs 39 ± 20 minutes, P = 0.57), and fluoroscopic (13 ± 7 vs 15 ± 10 minutes, P = 0.46) durations for MI ablation between the 2 arms. Clinically uneventful CS dissection occurred in 1 patient Temporary spot occlusion of CS is safe and significantly reduces the requirement of epicardial ablation to achieve MI block. It does not improve overall procedural success rate and procedural duration. Tissue cooling by CS blood flow is just one of the several challenges in MI ablation. © 2012 Wiley Periodicals, Inc.
Find related publications in this database (using NLM MeSH Indexing): Aged -; Atrial Fibrillation - diagnosis; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Balloon Occlusion - adverse effects; Catheter Ablation - adverse effects; Chi-Square Distribution -; Coronary Angiography -; Coronary Sinus - diagnostic imaging; Electrophysiologic Techniques, Cardiac -; Feasibility Studies -; Female -; France -; Humans -; Male -; Middle Aged -; Mitral Valve - physiopathology; Mitral Valve - surgery; Time Factors -; Treatment Outcome -
Find related publications in this database (Keywords): ablation; balloon; coronary sinus; mitral isthmus; occlusion