Epicardial course of the musculature related to the great cardiac vein: Anatomical considerations and clinical implications for mitral isthmus block after vein of Marshall ethanol infusion

Pambrun, Thomas; Derval, Nicolas; Duchâteau, Josselin; Denis, Arnaud; Chauvel, Rémi; Tixier, Romain; Welté, Nicolas; André, Clémentine; Nakashima, Takashi; Nakatani, Yosuke; Kamakura, Tsukasa; Takagi, Takamitsu; Ramirez, F. Daniel; Krisai, Philipp; Goujeau, Cyril; Cheniti, Ghassen; Vlachos, Konstantinos; Bourier, Félix; Takigawa, Masateru; Kitamura, Τakeshi; Frontera, Antonio; Sacher, Frédéric; Hocini, Mélèze; Haı̈ssaguerre, Michel; Jaı̈s, Pierre

doi:10.1016/j.hrthm.2021.06.1202

Cited by 23 publications

(31 citation statements)

References 20 publications

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“…However, there were still few patients for who block MI could not be achieved during operation. If MI and CS ablation cannot block the ablation line of MI, the Marshall ethanol infusion could be an additional ablation method to improve the block rate [21] .…”

Section: Linear Ablation Of MImentioning

confidence: 99%

Efficacy and safety linear ablation for persistent atrial fibrillation: PVI plus linear ablation of mitral isthmus and posterior box isolation

Liu

Cui

et al. 2022

Preprint

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For patients with persistent atrial fibrillation(PAF), whether linear ablation should be performed remains controversial, and the efficacy and safety for ablation index༈AI༉guided high energy linear ablation of mitral isthmus (MI) and left atrial (LA) posterior wall is still unclear. The aims of the this study were to assess the feasibility and clinical success rate of pulmonary veins isolation (PVI) combined with AI-guided high‐power linear ablation of LA roof and posterior inferior༈LA posterior wall isolation༉and MI for PAF patients. 200 consecutive PAF patients were enrolled. PVI combined with linear ablation of left atrial posterior wall isolation༈LAPWI༉ and MI were performed in all patients using AI-guided high-power pattern (ablation power was set to 45 W, targeting AI 400–500). The confirmation of the MI linear conduction block and LAPWI were performed after ablation. The procedure-related complication rate was 2.0%. During an average follow-up period of 24 months, freedom from atrial fibrillation or atrial tachycardia was achieved in 87.5% of the patients. Our ablation strategy of linear ablation was feasible and safe for PAF patients.

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Section: Linear Ablation Of MImentioning

confidence: 99%

Efficacy and safety linear ablation for persistent atrial fibrillation: PVI plus linear ablation of mitral isthmus and posterior box isolation

Liu

Cui

et al. 2022

Preprint

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“…A 2020 comparative study of 262 patients demonstrated a significantly higher rate of acute mitral isthmus block (98.7% vs. 63.6%) with adjunct Vein of Marshall ethanolization compared to RF only, with more durable block at repeat procedure [78]. A further publication from the same group again emphasized the high rate of mitral isthmus block achievable (98%) with Vein of Marshall ethanolization in combination with RF ablation endocardially and within the great cardiac vein [79]. Aside from its role in facilitating block at the mitral isthmus, the Vein of Marshall has been additionally implicated as a source of AF triggers and the site of parasympathetic and sympathetic nerve fibers important in the pathogenesis and maintenance of AF [80,81].…”

Section: Vein Of Marshall Ethanolizationmentioning

confidence: 99%

Catheter Ablation in Persistent AF, the Evolution towards a More Pragmatic Strategy

O’Neill

Wielandts

Gillis

et al. 2021

JCM

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Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide and represents a heterogeneous disorder with a complex pathological basis. While significant technological advances have taken place over the last decade in the field of catheter ablation of AF, response to ablation varies and long-term success rates in those with persistent AF remain modest. Mechanistic studies have highlighted potentially different sustaining factors for AF in the persistent AF population with substrate-driven focal and re-entrant sources in the body of the atria identified on invasive and non-invasive mapping studies. Translation to clinical practice, however, remains challenging and the application of such mapping techniques to clinical ablation has yet to demonstrate a significant benefit beyond pulmonary vein isolation (PVI) alone in the persistent AF cohort. Recent advances in catheter and ablation technology have centered on improving the durability of ablation lesions at index procedure and although encouraging results have been demonstrated with early studies, large-scale trials are awaited. Further meaningful improvement in clinical outcomes in the persistent AF population requires ongoing advancement in the understanding of AF mechanisms, coupled with continuing progress in catheter technology capable of delivering durable transmural lesions.

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“…1 This technique, pioneered by Valderrabano, facilitates left pulmonary vein (PV) isolation and mitral isthmus block. [2][3][4][5][6][7][8][9] Given that the VOM courses from the coronary sinus (CS) to the ridge of the left atrium (LA), a low voltage is expected in the vicinity of the left inferior PV. 10,11 However, the VOM forms a complex vascular network, and systematic and quantitative descriptions of VOM-induced tissue ablation are lacking.…”

Section: Introductionmentioning

confidence: 99%

“…Retrograde ethanol infusion into the vein of Marshall (VOM) has gained growing attention as a new therapeutic option for the treatment of atrial fibrillation (AF) and atrial tachycardia 1 . This technique, pioneered by Valderrabano, facilitates left pulmonary vein (PV) isolation and mitral isthmus block 2–9 . Given that the VOM courses from the coronary sinus (CS) to the ridge of the left atrium (LA), a low voltage is expected in the vicinity of the left inferior PV 10,11 .…”

Section: Introductionmentioning

confidence: 99%

Distribution of atrial low voltage induced by vein of Marshall ethanol infusion

Kamakura

André

Duchâteau

et al. 2022

Cardiovasc electrophysiol

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Introduction Systematic and quantitative descriptions of vein of Marshall (VOM)‐induced tissue ablation are lacking. We sought to characterize the distribution of low voltage observed in the left atrium (LA) after VOM ethanol infusion. Methods and Results The distribution of ethanol‐induced low voltage was evaluated by comparing high‐density maps performed before and after VOM ethanol infusion in 114 patients referred for atrial fibrillation ablation. The two most frequently impacted segments were the inferior portion of the ridge (82.5%) and the first half of the mitral isthmus (pulmonary vein side) (92.1%). Low‐voltage absence in these typical areas resulted from inadvertent ethanol infusion in the left atrial appendage vein (n = 3), initial VOM dissection (n = 3), or a “no branches” VOM morphology (n = 1). Visible anastomosis of the VOM with roof or posterior veins more frequently resulted in low‐voltage extension beyond typical areas, toward the entire left antrum (19.0% vs. 1.9%, p = .0045) or the posterior LA (39.7% vs. 3.8%, p < .001) but with a limited positive predictive value ranging from 29.4% to 43.5%. Ethanol‐induced low voltage covered a median LA surface of 3.6% (1.9%–5.0%) and did not exceed 8% of the LA surface in 90% of patients. Conclusion VOM ethanol infusion typically locates at the inferior ridge and the adjacent half of the mitral isthmus. Low‐voltage extensions can be anticipated but not guaranteed by the presence of visible anastomosis of the VOM with roof or posterior veins.

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Epicardial course of the musculature related to the great cardiac vein: Anatomical considerations and clinical implications for mitral isthmus block after vein of Marshall ethanol infusion

Cited by 23 publications

References 20 publications

Efficacy and safety linear ablation for persistent atrial fibrillation: PVI plus linear ablation of mitral isthmus and posterior box isolation

Efficacy and safety linear ablation for persistent atrial fibrillation: PVI plus linear ablation of mitral isthmus and posterior box isolation

Catheter Ablation in Persistent AF, the Evolution towards a More Pragmatic Strategy

Distribution of atrial low voltage induced by vein of Marshall ethanol infusion

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