4.1 | Feasibility and safety of VOM-EI
Hwang et al. first described the cannulation of the VOM in humans with a
microelectrode catheter inserted via the femoral vein for signal
analysis.12 Later, Valderrabano et al. used a right
jugular vein approach for the first procedures of VOM-EI reported in
humans and described a success rate of 86%.7 Kitamura
et al. adapted the technique for femoral access using a LIMA guiding
catheter introduced into a steerable sheath, with successful injection
of ethanol in 92.6% of cases.10 Other groups reported
successful VOM-EI rates of 73.4-92%.11,13,14. Using
the same approach, we successfully achieved VOM-EI in comparable 86% of
cases.
Reported complications of VOM-EI include vascular access complications,
pericardial effusion, pericarditis, VOM dissection and volume
overload.10,11,13 In our population of patients with
intended VOM-EI, we observed pericardial effusion/pericarditis in four
patients (18%) and VOM dissection in two (9%), all of which resolved
without additional interventions. We performed echocardiography the day
after VOM-EI in 86% of patients, irrespective of symptom status. This
strategy may have increased the incidence of clinically irrelevant
pericardial effusion compared to other groups not performing routine
echocardiography after VOM-EI.
The recent VENUS trial randomized patients to VOM-EI versus conventional
radiofrequency ablation for mitral isthmus ablation.11Overall complication rate was not different between groups. Of 185
patients randomized to VOM-EI, two patients suffered intraprocedural
pericardial effusion and two additional patients had a subacute
pericardial effusion requiring drainage. Another 11 patients had
subacute pericardial effusion/pericarditis not necessitating drainage.
Vascular access complications were present in three patients, stroke/TIA
in three and volume overload in ten. Nakashima et al. performed VOM-EI
in 152 patients and reported CS or VOM dissection in two cases and no
other major adverse events.13 Another study including
84 patients for VOM-EI reported pericardial effusion without
intervention in two patients and groin hematoma in
three.14 No complications were described among 32
patients undergoing VOM-EI in the study by Liu et
al.15