A Rossi

F Landra

G Mirizzi

L Panchetti

M Nesti

M Piacenti

P Marchese

S Garibaldi

S Taddeucci

U Startari

V Lionetti

English

Archivio della ricerca della Scuola Superiore Sant'Anna

Abstract citation ID: suae036.364ATRIAL VOLTAGE ANALYSIS FOLLOWING VEIN OF MARSHALL ETHANOLINFUSION PREDICTS MITRAL LINE BLOCKS. Taddeucci, S. Garibaldi, M. Nesti, F. Landra, U. Startari, L. Panchetti, G. Mirizzi,V. Lionetti, M. Piacenti, P. Marchese, and A. RossiAzienda Ospedaliera Universitaria Senese, Siena; Fondazione Toscana GabrieleMonasterio, Pisa; Ospedale C. E G. Mazzoni, Ascoli PicenoBackground: The vein of Marshall (VoM) is a promising target for atrial fibrillation(AF) treatment, matching with the ‘Coumel triangle‘ by housing triggers,autonomic connections, and serving as a substrate for perimitral flutters. Lateralmitral line (ML) represents a fundamental part for AF treatment, but achievingbidirectional block through endocardial ablations is challenging. VoM ethanolinfusion (VOM–EI) facilitates ML block, with the newly–formed bipolar lesionserving as an effectiveness index. Voltage analysis assessment after VOM–EI inpredicting ML block is poorly investigated.Purpose: To compare unipolar and bipolar low–voltage areas (LVAs) along VOMtrajectory after VOM–EI, and their role in predicting ML block.Methods: We enrolled 59 patients undergoing catheter ablation of persistent AF orML–dependent atrial flutter. High–density voltage mapping of left atrium wasfollowed by VOM–EI and LA remapping. The area width difference was obtainedand defined as ΔLVA. Normal bipolar voltage cutoffs were 0.50 mV in sinus rhythmor 0.29 mV in AF. Unipolar cutoffs were 2.7 mV and 1.1 mV, respectively. AfterVOM–EI, anatomical lesions included PVI, linear lesion for dome and ML isthmus.Systematic lines block validation was performed, defining ML block aftercoronary sinus (CS) electrograms sequence inversion (septal–to–lateral) duringleft atrial appendage pacing. Radiofrequency (RF) applications into the CS–greatcardiac vein targeted epicardial gaps if present. Ablation time for ML block(AblTime) was obtained.Results: In our cohort, 94.5% achieved ML block. Bipolar and unipolar low voltageareas after VOM–EI were 9,9 ± 6,9 cm2 and 12,2 ± 5,9 cm2 respectively. BipolarΔLVAs were significantly lower than unipolar ΔLVA (8.2 ± 6.5 cm2 vs. 9.4 ± 6.0cm2; p=0.03) (Fig 1). A strong linear correlation between AblTime and bipolarΔLVA (R: 0.76), and a significant correlation between AblTime and unipolar ΔLVA(R: 0.6) were found (Fig 2). Patients requiring RF applications into the CS for MLblock (13/59, 22%) showed lower ΔLVAs in logistic regression for both bipolar(p<0.01) and unipolar (p=0.03) analyses.Conclusions: VOM–EI induces unipolar LVAs wider than bipolar along the mitralisthmus trajectory. Unipolar and bipolar voltage analysis predicts a short time MLblock achievement. Moreover, wider unipolar and bipolar LVAs following VOM–EIcorrelates with higher likelihood to avoid the targeting of epicardial gaps via theCS musculature.Abstracts ii145Downloaded from https://academic.oup.com/eurheartjsupp/article/26/Supplement_2/ii145/7674443 by guest on 23 May 2024

ATRIAL VOLTAGE ANALYSIS FOLLOWING VEIN OF MARSHALL ETHANOL INFUSION PREDICTS MITRAL LINE BLOCK

https://www.iris.sssup.it/bitstream/11382/566172/1/suae036.364.pdf

ATRIAL VOLTAGE ANALYSIS FOLLOWING VEIN OF MARSHALL ETHANOL INFUSION PREDICTS MITRAL LINE BLOCK

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Archivio della ricerca della Scuola Superiore Sant'Anna