Role of the Vein of Marshall in Atrial Fibrillation Recurrences After Catheter Ablation: Therapeutic Effect of Ethanol Infusion

Abstract

VOM signals are consistently present in recurrent AF. VOM may rarely play a role in PV reconnection. However, VOM ethanol infusion can be useful in patients with recurrent AF after PVAI, assisting in achieving redisconnection of reconnected left PVs.

Ligament and vein of Marshall: A therapeutic opportunity in atrial fibrillation

“…We addressed the role of VOM in patients with recurrent atrial arrhythmias (tachycardia and AF) after a previous AF catheter ablation. 26 Unlike prior studies of this clinical scenario, we selectively cannulated the VOM for signal recording. VOM signals were consistently present in these cases, even after extensive prior endocardial ablation leading to endocardial scar in the LA ridge.…”

Ethanol for the treatment of cardiac arrhythmias

“…The VOM is a true atrial vein with capillary connections with the neighboring atrial myo-cardium [45], which implies that VOM ethanol infusion can lead to myocardial ablation in the neighboring tissues. We showed the role of VOM in providing epicardial connections to the left pulmonary veins leading to reconnections and clinical failures of catheter ablation of atrial fibrillation with pulmonary vein isolation [45].…”

“…We showed the role of VOM in providing epicardial connections to the left pulmonary veins leading to reconnections and clinical failures of catheter ablation of atrial fibrillation with pulmonary vein isolation [45]. Additionally, the VOM sits on the epicardial aspect of the left atrial ridge and the mitral isthmus – a critical region sustaining perimitral flutter.…”

“…Right heart shows endocardial aspect after incision in the left atrial appendage. A pale area of discoloration is shown anterior to the left pulmonary veins, surrounded by small area of tissue hemorrhage (arrowheads) (from Valderrábano et al [44] and Dave et al [45]).…”

Marshaling the Autonomic Nervous System for Treatment of Atrial Fibrillation

“…There is also evidence to suggest disruption of the ICN can have pro-arrhythmic effects on atrial tissue (23). Another limitation is that it is not possible to assess the contribution of atrial and PV myocardial junction ablation to the reduction of AF induction (24). There is also the clinical reality that the VOM is absent or too small to be cannulated in some patients, potentially increasing procedure time.…”