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Mitral Isthmus Ablation with and Without Temporary Spot Occlusion of the Coronary Sinus: A Randomized Clinical Comparison of Acute Outcomes
Author(s) -
HOCINI MÉLÈZE,
SHAH ASHOK J.,
NAULT ISABELLE,
RIVARD LENA,
LINTON NICK,
NARAYAN SANJIV,
MYIAZAKI SHINSUKE,
JADIDI AMIR S.,
KNECHT SÉBASTIEN,
SCHERR DANIEL,
WILTON STEPHEN B.,
ROTEN LAURENT,
PASCALE PATRIZIO,
PEDERSEN MICHALA,
DERVAL NICOLAS,
SACHER FRÉDÉRIC,
JAÏS PIERRE,
CLÉMENTY JACQUES,
HAÏSSAGUERRE MICHEL
Publication year - 2012
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2011.02248.x
Subject(s) - medicine , cardiology , coronary sinus , ablation , occlusion , coronary occlusion , randomized controlled trial
Role of CS Occlusion for Mitral Isthmus Ablation . 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. (J Cardiovasc Electrophysiol, Vol. 23, pp. 489‐496, May 2012)