Ethanol Infusion of Vein of Marshall for the Treatment of Persistent Atrial Fibrillation: The Basics and Clinical Practice

Bo He; Fang Zhao; Wenxi Yu; Yi Li; Xiaoyan Wu; Zhibing Lu

doi:10.3390/jcdd9080270

Ethanol Infusion of Vein of Marshall for the Treatment of Persistent Atrial Fibrillation: The Basics and Clinical Practice

J Cardiovasc Dev Dis. 2022 Aug 16;9(8):270. doi: 10.3390/jcdd9080270.

Authors

Bo He^{1

2

3}, Fang Zhao^{1

2

3}, Wenxi Yu^{1

2

3}, Yi Li^{1

2

3}, Xiaoyan Wu^{1

2

3}, Zhibing Lu^{1

2

3}

Affiliations

¹ Department of Cardiology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, China.
² Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.
³ Institute of Myocardial Injury and Repair, Wuhan University, Wuhan 430071, China.

Abstract

Catheter ablation for persistent atrial fibrillation (PeAF) is particularly challenging, as the clinical outcomes are modest. Pulmonary vein isolation (PVI) plus linear ablation is one of the main strategies for PeAF ablation. Completely durable transmural lesions are difficult to achieve by catheter ablation during mitral isthmus ablation. The ligament of Marshall contains the vein of Marshall (VOM), myocardial tracts and innervation, and serves as arrhythmogenic foci that make it an attractive target in catheter ablation of atrial fibrillation. Additionally, it co-localizes with the mitral isthmus, and may serve as a part of the perimitral isthmus reentrant circuit. Ethanol infusion into the VOM results in rapid ablation of the neighboring myocardium and its innervation. Its incorporation into PVI significantly increases the success rate of mitral isthmus block and the clinical outcome of PeAF ablation.

Keywords: epicardial connection; ethanol infusion; perimitral flutter; persistent atrial fibrillation; vein of Marshall.

Publication types

Review

Grants and funding

This work was supported by Grants from the National Natural Science Foundation of China (82070425 to Z.L.), the Natural Science Foundation of Hubei Province of China (2021CFA011 to Z.L.), the Health Commission of Hubei Province scientific research project (WJ2021Q039 to B.H.), the Translational Medicine and Interdiscipline Research Joint Fund of Zhongnan Hospital of Wuhan University (ZNLH201907 to Z.L.), and the Science and Technology Innovation cultivation fund of Zhongnan Hospital of Wuhan University (ZNPY2019005 to Z.L.).