{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T14:43:04Z","timestamp":1774622584519,"version":"3.50.1"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2022,11,10]],"date-time":"2022-11-10T00:00:00Z","timestamp":1668038400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,16]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>Bidirectional and durable block of mitral isthmus (MI) is essential for catheter ablation of persistent atrial fibrillation (PeAF) and perimitral flutter (PMF), but it remains a challenge. The aim of this study was to create a simple anatomical ablation strategy with minimal fluoroscopy that would yield a high success rate for MI block.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>Patients with PeAF or PMF were included. Mitral isthmus was ablated in a stepwise strategy. In Step 1, endocardial MI linear ablation was performed; in Step 2, ablation was targeted to the posterolateral portion of the left atrium along the MI line; in Step 3, epicardial ablation within the coronary sinus (CS) was performed across the MI line to the ostium of the vein of Marshall (VOM) or performed within the VOM if available; in Step 4, the catheter was rotated and ablated in the CS to isolate the CS; and in Step 5, the early activation site with complex component potential above the MI line during distal CS pacing was considered as the ablation target. All patients were followed up. A total of 178 (17 patients with mechanical prosthetic mitral valve) were included. One hundred and sixty-six patients achieved a confirmed MI bidirectional conduction block (93%). One patient had cardiac tamponade. Four patients showed re-conduction across the MI line during a repeated ablation. In the latest follow-up [12 (7, 16) months], 161 of 178 (90%) patients maintained their sinus rhythm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A simple stepwise anatomical ablation strategy for MI shows a high success rate with low fluoroscopy exposure.<\/jats:p><\/jats:sec>","DOI":"10.1093\/europace\/euac204","type":"journal-article","created":{"date-parts":[[2022,11,10]],"date-time":"2022-11-10T08:00:07Z","timestamp":1668067207000},"page":"610-618","source":"Crossref","is-referenced-by-count":11,"title":["Simplified stepwise anatomical ablation strategy for mitral isthmus: efficacy, efficiency, safety, and outcome"],"prefix":"10.1093","volume":"25","author":[{"given":"Xiaoqin","family":"Li","sequence":"first","affiliation":[{"name":"Department of Cardiology, Chongqing General Hospital, University of Chinese Academy of Sciences , 118 Xingguang Road, Yubei District, 401120 Chongqing , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mengmeng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Peking University Third Hospital , Beijing , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1367-1092","authenticated-orcid":false,"given":"Yuan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Chongqing General Hospital, University of Chinese Academy of Sciences , 118 Xingguang Road, Yubei District, 401120 Chongqing , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8362-1926","authenticated-orcid":false,"given":"Hao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Chongqing General Hospital, University of Chinese Academy of Sciences , 118 Xingguang Road, Yubei District, 401120 Chongqing , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenli","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Chongqing General Hospital, University of Chinese Academy of Sciences , 118 Xingguang Road, Yubei District, 401120 Chongqing , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boli","family":"Ran","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Chongqing General Hospital, University of Chinese Academy of Sciences , 118 Xingguang Road, Yubei District, 401120 Chongqing , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoli","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Chongqing General Hospital, University of Chinese Academy of Sciences , 118 Xingguang Road, Yubei District, 401120 Chongqing , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qianmei","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Chongqing General Hospital, University of Chinese Academy of Sciences , 118 Xingguang Road, Yubei District, 401120 Chongqing , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8938-4797","authenticated-orcid":false,"given":"Biao","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Chongqing General Hospital, University of Chinese Academy of Sciences , 118 Xingguang Road, Yubei District, 401120 Chongqing , China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,11,10]]},"reference":[{"key":"2023021623541197600_","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1093\/europace\/euaa293","article-title":"Pulmonary vein isolation alone vs. more extensive ablation with 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Cardiovasc Electrophysiol"},{"key":"2023021623541197600_","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1093\/europace\/euy327","article-title":"The importance of identifying conduction breakthrough sites across the mitral isthmus by elaborate mapping for mitral isthmus linear ablation","volume":"21","author":"Chen","year":"2019","journal-title":"Europace"},{"key":"2023021623541197600_","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.hrthm.2017.07.033","article-title":"Spectrum of atrial arrhythmias using the ligament of Marshall in patients with atrial fibrillation","volume":"15","author":"Chugh","year":"2018","journal-title":"Heart Rhythm"},{"key":"2023021623541197600_","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1111\/pace.14263","article-title":"Feasibility, efficacy, and safety of ethanol infusion into the vein of Marshall for atrial fibrillation: a meta-analysis","volume":"44","author":"He","year":"2021","journal-title":"Pacing Clin 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