Document Detail


Mitral isthmus ablation with and without temporary spot occlusion of the coronary sinus: a randomized clinical comparison of acute outcomes.
MedLine Citation:
PMID:  22229972     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate the safety and outcomes of mitral isthmus (MI) linear ablation with temporary spot occlusion of the coronary sinus (CS). Background: CS blood flow cools local tissue precluding transmurality and bidirectional block across MI lesion.
METHODS: 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.
RESULTS: 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
CONCLUSIONS: 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.
Authors:
Mélèze Hocini; Ashok J Shah; Isabelle Nault; Lena Rivard; Nick Linton; Sanjiv Narayan; Shinsuke Myiazaki; Amir S Jadidi; Sébastien Knecht; Daniel Scherr; Stephen B Wilton; Laurent Roten; Patrizio Pascale; Michala Pedersen; Nicolas Derval; Frédéric Sacher; Pierre Jaïs; Jacques Clémenty; Michel Haïssaguerre
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2012-01-09
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  23     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-05-08     Completed Date:  2012-09-04     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  489-96     Citation Subset:  IM    
Copyright Information:
© 2012 Wiley Periodicals, Inc.
Affiliation:
Hôpital Cardiologique du Haut Lévêque Université Victor Segalen Bordeaux II, Bordeaux, Pessac, France. meleze.hocini@chu-bordeaux.fr
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MeSH Terms
Descriptor/Qualifier:
Aged
Atrial Fibrillation / diagnosis,  physiopathology,  surgery*
Balloon Occlusion* / adverse effects
Catheter Ablation* / adverse effects
Chi-Square Distribution
Coronary Angiography
Coronary Sinus* / radiography
Electrophysiologic Techniques, Cardiac
Feasibility Studies
Female
France
Humans
Male
Middle Aged
Mitral Valve / physiopathology,  surgery*
Time Factors
Treatment Outcome
Grant Support
ID/Acronym/Agency:
K24 HL103800/HL/NHLBI NIH HHS; R01 HL083359/HL/NHLBI NIH HHS
Comments/Corrections
Comment In:
J Cardiovasc Electrophysiol. 2012 May;23(5):497-8   [PMID:  22172008 ]

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