Ethanol infusion in the vein of Marshall facilitates mitral isthmus ablation

José L. Báez-Escudero, Percy Francisco Morales, Amish S. Dave, Christine M. Sasaridis, Young Hoon Kim, Kaoru Okishige, Miguel Valderrábano

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Background: Treatment of perimitral flutter (PMF) requires bidirectional mitral isthmus (MI) block, which can be difficult with radiofrequency ablation (RFA). The vein of Marshall (VOM) is located within the MI. Objective: To test whether VOM ethanol infusion could help achieve MI block. Methods: Perimitral conduction was studied in patients undergoing ablation of atrial fibrillation. Group 1 included 50 patients with a previous atrial fibrillation ablation undergoing repeat ablation, 30 of whom had had MI ablation. Spontaneous (8 of 50) or inducible PMF (21 of 50) was confirmed by activation mapping. Group 2 included 21 patients undergoing de novo VOM ethanol infusion. The VOM was cannulated with a quadripolar catheter for pacing and with an angioplasty balloon to deliver up to four 1-mL infusions of 98% ethanol. Voltage maps were created before and after VOM ethanol infusion. Bidirectional MI block was verified by differential pacing. RFA times required to achieve it were assessed. Results: In group 1, VOM ethanol infusion acutely terminated PMF in 5 of 29 patients. RFA needed to achieve bidirectional MI block was 2.2 ± 1.6 minutes. Presence of PMF or previous MI ablation did not affect RFA times. In group 2, RFA needed to achieve bidirectional MI block was 2.0 ± 1.6 minutes (P = NS). Five patients had bidirectional MI block achieved solely by VOM ethanol infusion without RFA. In both groups, ablation after VOM ethanol infusion was required in the annular aspect of the MI. There were no acute complications. Conclusion: VOM ethanol infusion is useful in the treatment of PMF and assists in reliably achieving bidirectional MI block.

Original languageEnglish
Pages (from-to)1207-1215
Number of pages9
JournalHeart Rhythm
Volume9
Issue number8
DOIs
Publication statusPublished - 2012 Aug 1

Fingerprint

Veins
Ethanol
Atrial Fibrillation
carbosulfan
Balloon Angioplasty
Catheters
Therapeutics

Keywords

  • Atrial fibrillation
  • Ethanol
  • Perimitral flutter
  • Vein of Marshall

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Báez-Escudero, J. L., Morales, P. F., Dave, A. S., Sasaridis, C. M., Kim, Y. H., Okishige, K., & Valderrábano, M. (2012). Ethanol infusion in the vein of Marshall facilitates mitral isthmus ablation. Heart Rhythm, 9(8), 1207-1215. https://doi.org/10.1016/j.hrthm.2012.03.008

Ethanol infusion in the vein of Marshall facilitates mitral isthmus ablation. / Báez-Escudero, José L.; Morales, Percy Francisco; Dave, Amish S.; Sasaridis, Christine M.; Kim, Young Hoon; Okishige, Kaoru; Valderrábano, Miguel.

In: Heart Rhythm, Vol. 9, No. 8, 01.08.2012, p. 1207-1215.

Research output: Contribution to journalArticle

Báez-Escudero, JL, Morales, PF, Dave, AS, Sasaridis, CM, Kim, YH, Okishige, K & Valderrábano, M 2012, 'Ethanol infusion in the vein of Marshall facilitates mitral isthmus ablation', Heart Rhythm, vol. 9, no. 8, pp. 1207-1215. https://doi.org/10.1016/j.hrthm.2012.03.008
Báez-Escudero JL, Morales PF, Dave AS, Sasaridis CM, Kim YH, Okishige K et al. Ethanol infusion in the vein of Marshall facilitates mitral isthmus ablation. Heart Rhythm. 2012 Aug 1;9(8):1207-1215. https://doi.org/10.1016/j.hrthm.2012.03.008
Báez-Escudero, José L. ; Morales, Percy Francisco ; Dave, Amish S. ; Sasaridis, Christine M. ; Kim, Young Hoon ; Okishige, Kaoru ; Valderrábano, Miguel. / Ethanol infusion in the vein of Marshall facilitates mitral isthmus ablation. In: Heart Rhythm. 2012 ; Vol. 9, No. 8. pp. 1207-1215.
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abstract = "Background: Treatment of perimitral flutter (PMF) requires bidirectional mitral isthmus (MI) block, which can be difficult with radiofrequency ablation (RFA). The vein of Marshall (VOM) is located within the MI. Objective: To test whether VOM ethanol infusion could help achieve MI block. Methods: Perimitral conduction was studied in patients undergoing ablation of atrial fibrillation. Group 1 included 50 patients with a previous atrial fibrillation ablation undergoing repeat ablation, 30 of whom had had MI ablation. Spontaneous (8 of 50) or inducible PMF (21 of 50) was confirmed by activation mapping. Group 2 included 21 patients undergoing de novo VOM ethanol infusion. The VOM was cannulated with a quadripolar catheter for pacing and with an angioplasty balloon to deliver up to four 1-mL infusions of 98{\%} ethanol. Voltage maps were created before and after VOM ethanol infusion. Bidirectional MI block was verified by differential pacing. RFA times required to achieve it were assessed. Results: In group 1, VOM ethanol infusion acutely terminated PMF in 5 of 29 patients. RFA needed to achieve bidirectional MI block was 2.2 ± 1.6 minutes. Presence of PMF or previous MI ablation did not affect RFA times. In group 2, RFA needed to achieve bidirectional MI block was 2.0 ± 1.6 minutes (P = NS). Five patients had bidirectional MI block achieved solely by VOM ethanol infusion without RFA. In both groups, ablation after VOM ethanol infusion was required in the annular aspect of the MI. There were no acute complications. Conclusion: VOM ethanol infusion is useful in the treatment of PMF and assists in reliably achieving bidirectional MI block.",
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AU - Morales, Percy Francisco

AU - Dave, Amish S.

AU - Sasaridis, Christine M.

AU - Kim, Young Hoon

AU - Okishige, Kaoru

AU - Valderrábano, Miguel

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N2 - Background: Treatment of perimitral flutter (PMF) requires bidirectional mitral isthmus (MI) block, which can be difficult with radiofrequency ablation (RFA). The vein of Marshall (VOM) is located within the MI. Objective: To test whether VOM ethanol infusion could help achieve MI block. Methods: Perimitral conduction was studied in patients undergoing ablation of atrial fibrillation. Group 1 included 50 patients with a previous atrial fibrillation ablation undergoing repeat ablation, 30 of whom had had MI ablation. Spontaneous (8 of 50) or inducible PMF (21 of 50) was confirmed by activation mapping. Group 2 included 21 patients undergoing de novo VOM ethanol infusion. The VOM was cannulated with a quadripolar catheter for pacing and with an angioplasty balloon to deliver up to four 1-mL infusions of 98% ethanol. Voltage maps were created before and after VOM ethanol infusion. Bidirectional MI block was verified by differential pacing. RFA times required to achieve it were assessed. Results: In group 1, VOM ethanol infusion acutely terminated PMF in 5 of 29 patients. RFA needed to achieve bidirectional MI block was 2.2 ± 1.6 minutes. Presence of PMF or previous MI ablation did not affect RFA times. In group 2, RFA needed to achieve bidirectional MI block was 2.0 ± 1.6 minutes (P = NS). Five patients had bidirectional MI block achieved solely by VOM ethanol infusion without RFA. In both groups, ablation after VOM ethanol infusion was required in the annular aspect of the MI. There were no acute complications. Conclusion: VOM ethanol infusion is useful in the treatment of PMF and assists in reliably achieving bidirectional MI block.

AB - Background: Treatment of perimitral flutter (PMF) requires bidirectional mitral isthmus (MI) block, which can be difficult with radiofrequency ablation (RFA). The vein of Marshall (VOM) is located within the MI. Objective: To test whether VOM ethanol infusion could help achieve MI block. Methods: Perimitral conduction was studied in patients undergoing ablation of atrial fibrillation. Group 1 included 50 patients with a previous atrial fibrillation ablation undergoing repeat ablation, 30 of whom had had MI ablation. Spontaneous (8 of 50) or inducible PMF (21 of 50) was confirmed by activation mapping. Group 2 included 21 patients undergoing de novo VOM ethanol infusion. The VOM was cannulated with a quadripolar catheter for pacing and with an angioplasty balloon to deliver up to four 1-mL infusions of 98% ethanol. Voltage maps were created before and after VOM ethanol infusion. Bidirectional MI block was verified by differential pacing. RFA times required to achieve it were assessed. Results: In group 1, VOM ethanol infusion acutely terminated PMF in 5 of 29 patients. RFA needed to achieve bidirectional MI block was 2.2 ± 1.6 minutes. Presence of PMF or previous MI ablation did not affect RFA times. In group 2, RFA needed to achieve bidirectional MI block was 2.0 ± 1.6 minutes (P = NS). Five patients had bidirectional MI block achieved solely by VOM ethanol infusion without RFA. In both groups, ablation after VOM ethanol infusion was required in the annular aspect of the MI. There were no acute complications. Conclusion: VOM ethanol infusion is useful in the treatment of PMF and assists in reliably achieving bidirectional MI block.

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