| Mitral isthmus ablation with and without temporary spot occlusion of the coronary sinus: a randomized clinical comparison of acute outcomes. | |
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MedLine Citation:
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PMID: 22229972 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article; Randomized Controlled Trial Date: 2012-01-09 |
Journal Detail:
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Title: Journal of cardiovascular electrophysiology Volume: 23 ISSN: 1540-8167 ISO Abbreviation: J. Cardiovasc. Electrophysiol. Publication Date: 2012 May |
Date Detail:
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Created Date: 2012-05-08 Completed Date: 2012-09-04 Revised Date: 2013-05-22 |
Medline Journal Info:
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Nlm Unique ID: 9010756 Medline TA: J Cardiovasc Electrophysiol Country: United States |
Other Details:
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Languages: eng Pagination: 489-96 Citation Subset: IM |
Copyright Information:
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© 2012 Wiley Periodicals, Inc. |
Affiliation:
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Hôpital Cardiologique du Haut Lévêque Université Victor Segalen Bordeaux II, Bordeaux, Pessac, France. meleze.hocini@chu-bordeaux.fr |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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:
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K24 HL103800/HL/NHLBI NIH HHS; R01 HL083359/HL/NHLBI NIH HHS |
| Comments/Corrections | |
Comment In:
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J Cardiovasc Electrophysiol. 2012 May;23(5):497-8
[PMID:
22172008
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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