ArticleJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing2025
Acute mitral isthmus block in patients undergoing catheter ablation for atrial fibrillation: efficacy and safety of a systematic stepwise approach.
Article in Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Acute Efficacy of Pulsed-Field Ablation of the Mitral Isthmus Using a Pentaspline Catheter and Two Different Ablation Settings.Journal of cardiovascular electrophysiology · 2026Article
- Modified stepwise method with the guidance of QDOT MICRO catheter for mitral isthmus ablation in patients with persistent atrial fibrillation.Frontiers in cardiovascular medicine · 2026Article
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Authors and funding
9 authors.
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Abstract
backgroundMitral isthmus (MI) line ablation is associated with a higher success rate of ablation for atrial fibrillation (AF), but completely blocking the MI is often challenging. The purpose of this study was to assess the effectiveness and safety of a systematic, step-by-step approach for completely blocking the MI in patients with AF undergoing MI line ablation for the first time.
methodsA total of 338 consecutive AF patients who underwent MI ablation for the first time were included in the study. MI line ablation was performed in the following sequence: Step 1 involved endocardial linear ablation from the mitral annulus to the left inferior pulmonary vein; Step 2 involved epicardial ablation in the coronary sinus (CS), next to the endocardial ablation line; Step 3 involved epicardial-endocardial insertion site mapping and ablation; Step 4 involved ethanol infusion of the vein of Marshall (EIVOM); and Step 5 involved ablation of the ostium of the VOM, followed by Step 3 if needed. The complete MI block was evaluated using differential pacing maneuvres.
resultsAfter endocardial linear ablation, 111 patients (32.8%) experienced MI block. Further epicardial ablation in the CS induced MI block in another 89 patients (26.3%). In 42 patients (12.4%), epicardial-endocardial insertion sites were ablated to block the MI. EIVOM was performed in 64 patients (18.9%) to achieve MI block. Ablation at the ostium of the VOM induced MI block in 3 patients, and repeating step 3 induced MI block in 17 patients. The total success rate of MI block was 96.4%. No cardiac tamponade occurred during MI ablation.
conclusionsWith a systematic stepwise approach, acute bidirectional MI block can be achieved with a high success rate and without severe complications.
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