https://orcid.org/0000-0002-9897-6807
Vein of Marshall (VOM) ethanol infusion can increase the efficacy of catheter ablation for atrial fibrillation (AF) or perimitral flutter. Localizing the VOM can be challenging and impede ethanol infusion with limited therapeutic alternatives.
We report six cases of catheter ablation in which we tried to overcome such situations by using a novel technique to identify the VOM. The median age was 72 years and two subjects were females. Four patients had AF and two had perimitral flutter, most of these arrhythmias were relapses. In all patients, standard approaches (direct contrast injection and selective contrast injection) failed to image the VOM, leading us to attempt downstream from occlusion contrast injection (DOCI). A Swan–Ganz catheter was inserted through the sheath lumen into the coronary sinus (CS). The CS was occluded by balloon inflation. Then, we infused contrast through the sheath to obtain an opacification downstream from occlusion and reveal the end of the CS where the VOM was expected to lie (Panels A and B).
Downstream from occlusion contrast injection was feasible in all subjects and allowed VOM visualization (see Supplementary material online, Video S1) in five patients. It resulted in one asymptomatic VOM dissection. Among the five DOCI successes, VOM catheterization and ethanol infusion could be performed in four patients.
Supplementary material
Supplementary material is available at Europace online.
The full-length version of this report can be viewed at: https://www.escardio.org/Education/E-Learning/Clinical-cases/Electrophysiology.
