Clinical trial finds combined procedures better for persistent atrial fibrillation

Medical Xpress / JAMA ^ | Nov. 25, 2024 | Justin Jackson / Caihua Sang et al

[ConservativeMind]

Research conducted across 12 hospitals in China has discovered that combining linear ablation with ethanol infusion via the vein of Marshall (EIVOM) alongside pulmonary vein isolation (PVI) significantly improves sinus rhythm maintenance in patients suffering from persistent atrial fibrillation.

Atrial fibrillation (AF) is when the heart's upper chambers beat irregularly and often too fast due to misfiring electrical impulses. This can cause blood clots and other heart problems.

Treating persistent AF is challenging because standard methods used to break up irregular electrical impulses with scar tissue, like PVI, don't always work well over the long term.

EIVOM involves injecting alcohol into a tiny vein on the heart's surface. The alcohol creates a controlled chemical scar, helping to block the abnormal electrical pathways. With linear ablation, doctors create straight lines of scar tissue in specific areas of the heart, preventing the spread of irregular electrical signals.

In the study, a cohort of 498 patients was randomized to undergo PVI alone or PVI plus EIVOM and linear ablation. Of the 498 randomized patients, 495 were included in the primary analysis.

The intervention group received EIVOM first, followed by PVI and linear ablation targeting the left atrial roof, mitral isthmus, and cavotricuspid isthmus. The primary objective focused on maintaining freedom from any documented atrial arrhythmias lasting more than 30 seconds without the use of antiarrhythmic drugs over a 12-month period.

The findings revealed that 70.7% of patients who received the combined treatment were free from irregular heartbeats without needing medication after one year, compared to 61.5% of patients who had only the standard PVI treatment. This difference yielded a hazard ratio of 0.73, indicating statistical significance.

Both groups had similar rates of side effects, although the combined treatment group had slightly more cases of mild heart inflammation that didn't require additional treatment.

[ConservativeMind]

Controlled scarring with linear ablation improved the number of people irregular heartbeat free from 61.5% to 70.7%, at the one year point.

[ConservativeMind]

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[Responsibility2nd]

AFib Ping

[E. Pluribus Unum]

I had atrial fibrillation for two solid years.

My cardiologist was talking about ablation and/or a pacemaker.

He wanted me to drink 64 ounces of water a day, and I got tired of it.

I started drinking 64 ounces of low-sodium V8 juice every day.

After a couple of weeks my Kardia Mobile EKG device that I use daily went from possible atrial fibrillation to Normal Sinus Rhythm.

Turns out low-sodium V8 is loaded with potassium, and I had been low on potassium.

I have gone 93 solid days afib-free after having afib for two solid years.

My cardiologist says ablation and/or a pacemaker are no longer necessary because my heart has gone from 13% extraction factor to 50%+ for all four extraction factor numbers.

If you have afib, you might try drinking low-sodium V8 for a couple of weeks and see what happens.

It can’t hurt anything.

[E. Pluribus Unum]

Ejection fraction, not extraction fraction.

[Bobbyvotes]

My neighbor has Afibs. His cardiac doctor ordered quadruple bypass surgery. Neighbor has been released from hospital and healing from open heart surgery.

[Bobbyvotes]

Good suggestion to try. Can’t hurt except more acidity in stomach, which can be easily controlled with Tums.

[packagingguy]

“Ethanol infusion”

The liquor store is open for two more hours. Should I give it a try?

[E. Pluribus Unum]

I finally quit drinking it every day because of the canker sores in my mouth from the acid.

[ckilmer]

I had a cryogenic ablation done about 10 years ago.

I’ve had no trouble with Affib since.

I thank God and the surgeon for allowing me to experience a miracle.

Amen.

[ConservativeMind]

My wife and I drink that exact same low sodium V-8.

You choose very well.

[catnipman]

“I had a cryogenic ablation done about 10 years ago. I’ve had no trouble with Afib since.”

ditto ... mine was done by dr. wilbur su at banner in phoenix ... one of the top operators of cryogenic PVI ablation in the U.S. ...

the chinese study was done using PVI ablation with radiofrequency energy, a vastly inferior PVI ablation method compared to cryoablation performed by an experienced operator ...

[A Navy Vet]

Thanks for your info. I have AFib also and have a script for Eliquis I just started taking. When preparing for a gall bladder removal, the hospital discovered AFib and wouldn't operate until they normalized my heart. Interestingly, that they did that by loads of potassium drip for a day and night.

Sucks getting older. I'm 74.