Efficacy And Safety Of Radiofrequency Catheter Ablation Combined With Vein Of Marshall Ethanol Chemical Ablation In The Treatment Of Persistent Atrial Fibrillation

Objective:To observe the combination of radiofrequency catheter ablation(RFCA)and vein of Marshall ethanol chemical ablation(EIVOM)in the treatment of persistent atrial fibrillation(PAF)and the complete block rate of mitral isthmus,and further evaluate the safety and efficacy of radiofrequency catheter ablation combined with vein of Marshall ethanol chemical ablation in the treatment of persistent atrial fibrillation to improve the quality of life in patients with atrial fibrillation.Methods:This study is a retrospective clinical study.A retrospective collection of 198 patients who were hospitalized in the Second Department of Cardiovascular Medicine of Gansu Provincial People’s Hospital from January 2019 to January 2022 and were diagnosed with persistent atrial fibrillation and received radiofrequency ablation for the first time,according to The inclusion and exclusion criteria were screened,and finally 184 patients met the inclusion criteria and were included in this study.According to whether Marshall intravenous ethanol injection was performed,the patients were divided into catheter radiofrequency ablation combined with Marshall intravenous ethanol chemical ablation group(EIVOM group)83 cases and catheter radiofrequency ablation group(RF group)101 cases.Catheter radiofrequency ablation includes pulmonary vein isolation + linear ablation(mitral isthmus,tricuspid isthmus,and roof of the left atrium).The clinical data of patients between the two groups were compared,and age,sex,body mass index,history of hypertension,history of diabetes,history of coronary heart disease,history of heart failure,history of old stroke,left atrial diameter,left ventricular end-diastolic diameter,Left ventricular ejection fraction,CHA2DS2‐VASc integral,troponin I,NT-pro BNP,and 14 factors were used for propensity score matching(PSM)at a ratio of 1:1,and finally there were 60 patients in each of the two groups.All patients underwent radiofrequency catheter ablation or radiofrequency catheter ablation(RFCA)combined with Marshall intravenous ethanol chemical ablation under the guidance of the Ensite Nav X threedimensional mapping system.According to the symptoms,the mitral isthmus block rate was compared between the two groups and the safety evaluation was carried out.All patients enrolled in the group underwent outpatient reexamination or telephone follow-up at 3,6,and12 months after operation to record the recurrence of atrial fibrillation and the occurrence of complications,and compare the effects of the two surgical methods on the recurrence of atrial fibrillation.The Kaplan‐Meier survival curve analysis was used to compare the 1-year AF recurrence-free survival of the two surgical methods,and COX multivariate regression was used to observe whether EIVOM was a favorable factor for reducing the recurrence of AF.Results:Compared with the clinical data of the EIVOM group and the RF group,there were statistical differences in left atrial diameter,troponin I,CHA2DS2-VASc score,and history of heart failure,P<0.05.In order to reduce the influence of differences between groups on the target observation indicators,after PSM,there were 34 males(56.7%)and 26 females(43.3%)in the EIVOM group,with an average age of(62.93±8.58)years;41 males(68.3%)in the RF group %),19 females(31.7%),with an average age of(63.18±8.61)years old.There was no significant difference in general data between the two groups,P>0.05.A total of 56cases(93.3%)of the mitral valve isthmus block were successfully blocked in the EIVOM group,and 47 cases(78.3%)were successfully blocked in the RF group.The bidirectional block rate of the mitral valve isthmus in the EIVOM group was higher than that in the RF group(P=0.036).The recurrence of atrial fibrillation within 1 year of follow-up: 8 cases(13.3%)of AF recurrence in EIVOM group,17 cases(28.3%)of RF group recurrence,the recurrence rate of AF within 1year in EIVOM group was lower than that of RF group(P=0.043).Kaplan-Meier survival curve analysis showed that the survival rate of AF-free recurrence in EIVOM group was significantly higher than that in RF group(P=0.048).Using multivariate COX regression analysis,it was found that compared with the RF group,Marshall intravenous ethanol injection(EIVOM group)was indeed a protective factor for the recurrence of atrial fibrillation(HR:0.305,95%CI: 0.110-0.848,P=0.023).Intraoperative and postoperative complications: In the EIVOM group,2patients had pericardial tamponade and 3 patients had inguinal hematoma.A small amount of pericardial effusion occurred in 1 patient 1 month after operation.In the RF group,a small amount of pericardial effusion was observed in 1 patient,and inguinal hematoma was observed in 5 patients.A small amount of pericardial effusion occurred in 1 patient 2 months after operation.Compared with the RF group,there was no increase in surgical complications in the EIVOM group(P>0.05).The above complications were improved after active symptomatic treatment,and no other serious complications such as anaphylactic shock,esophageal fistula,coronary sinus dissection,and death were found.Conclusion:In patients with persistent atrial fibrillation,compared with catheter radiofrequency ablation,catheter radiofrequency ablation combined with Marshall intravenous absolute ethanol chemical ablation can increase the rate of bidirectional blockage of the mitral valve isthmus,significantly reduce the recurrence rate of atrial fibrillation within 1 year,and will not Increased intraoperative and postoperative complications,catheter radiofrequency ablation combined with vein of Marshall treatment of persistent atrial fibrillation is effective and safe.