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Okishige K, Kawaguchi N, Shigeta T, Yamauchi Y, Sasaki T, Keida T, Tanno K, Hirao K, Sasano T. Quantitative investigation of acute lesions created by ethanol infusion into the vein of Marshall. Heart Rhythm 2024:S1547-5271(24)02828-5. [PMID: 38960305 DOI: 10.1016/j.hrthm.2024.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 06/25/2024] [Accepted: 06/25/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Ethanol infusion into the vein of Marshall (EIVOM) has been performed as an adjunctive atrial fibrillation therapy. However, the time course change, quantitative lesion investigation, and effects on epicardial fat pads and fractionated atrial electrograms created by EIVOM have never been investigated. OBJECTIVE This study aimed to perform a quantitative analysis of lesions created by EIVOM. METHODS We created voltage maps using a 3-dimensional mapping system immediately before and 30 minutes and 60 minutes after performing EIVOM to study the time course change in the lesions. We compared differences in the average contact force value required for successful conduction block in the Marshall vein area of patients with and without EIVOM. We also investigated effects of EIVOM on the area of complex fractionated atrial electrograms before and after EIVOM. We measured the total epicardial fat pad volume before and after EIVOM by computed tomography. RESULTS Voltage was significantly reduced after EIVOM, and there were significant differences in voltage reduction between the control status and 30 minutes and 60 minutes after EIVOM (P < .05). The average contact force value was significantly lower with vs without EIVOM (P < .05). The total epicardial fat volume and complex fractionated atrial electrogram area also significantly decreased after EIVOM (P < .05). CONCLUSION EIVOM provided significant therapeutic effects on the left atrial tissue perpetuating atrial fibrillation, which was demonstrated by a quantitative analysis.
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Affiliation(s)
- Kaoru Okishige
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Kanagawa, Japan.
| | - Naohiko Kawaguchi
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Kanagawa, Japan
| | - Takatoshi Shigeta
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Kanagawa, Japan
| | - Yasuteru Yamauchi
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Kanagawa, Japan
| | - Takeshi Sasaki
- Arrhythmia Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takehiko Keida
- Department of Cardiology, Edogawa Hospital, Tokyo, Japan
| | - Kaoru Tanno
- Department of Cardiology, Syowa University, School of Medicine, Tokyo, Japan
| | - Kenzo Hirao
- Arrhythmia Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Arrhythmia Center, Tokyo Medical and Dental University, Tokyo, Japan
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Shimizu Y, Yoshitani K, Kuriyama T, Mori K, Kujira K, Imai M, Fukuhara R, Taniguchi R, Toma M, Miyamoto T, Sato Y. The effect of an initial catheter ablation with an adjunctive ethanol infusion into the vein of Marshall on persistent atrial fibrillation. J Cardiovasc Electrophysiol 2024; 35:453-460. [PMID: 38282242 DOI: 10.1111/jce.16191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/03/2024] [Accepted: 01/12/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION Some previous studies have reported that a first-step ethanol infusion into the vein of Marshall (EIVOM) with touch-up radiofrequency (RF) ablation can facilitate mitral isthmus (MI) block and improves the ablation outcomes in persistent atrial fibrillation (PeAF) patients. However, the effect of an initial RF ablation with an adjunctive EIVOM has not been fully investigated. METHODS This study enrolled 233 PeAF patients undergoing pulmonary vein isolation and linear ablation including an MI, roof line, and cavotricuspid isthmus ablation. An EIVOM was performed when endocardial ablation with or without coronary sinus ablation failed to create MI block. RESULTS Bidirectional MI block was achieved in 224 patients (96.1%). Among them, MI block was obtained by only RF ablation in 174/224 patients (77.7%) (RF group) and an adjunctive EIVOM was needed in 50/224 (22.3%) (EIVOM group). During the follow-up, 113 (64.9%) RF group patients were free from AF/atrial tachycardia compared to 41 (82.0%) EIVOM group patients (log-rank p = .045). In a multivariate Cox regression analysis, an adjunctive EIVOM was associated with a lower recurrence rate (hazard ratio = 0.39, 95% confidence interval = 0.17-0.78, p = .006). CONCLUSION An initial RF ablation with an adjunctive EIVOM strategy improved MI ablation's acute success rate and was associated with better clinical outcomes.
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Affiliation(s)
- Yukiko Shimizu
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | | | - Tomoari Kuriyama
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Kazuki Mori
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Kazuto Kujira
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Masao Imai
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Rei Fukuhara
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Tadashi Miyamoto
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2021; 37:709-870. [PMID: 34386109 PMCID: PMC8339126 DOI: 10.1002/joa3.12491] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Maeda S, Okishige K, Tsuda Y, Yonai R, Kawashima T, Liang JJ, Arroyo RC, Kawabata M, Atarashi H, Hirao K. Coronary Arterial Vasospasm: A Rare Complication of Vein of Marshall Ethanol Infusion for Atrial Fibrillation. JACC Case Rep 2021; 2:1766-1770. [PMID: 34317053 PMCID: PMC8312119 DOI: 10.1016/j.jaccas.2020.06.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/19/2020] [Accepted: 06/30/2020] [Indexed: 11/16/2022]
Abstract
A 75-year-old man was admitted for repeat ablation of atrial fibrillation. At 30 min after infusion of 3.5 ml of ethanol into the vein of Marshall, inferior ST-segment elevation with coronary arterial vasospasm was observed. This is the first report of coronary vasospasm after chemical ablation of the vein of Marshall. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Shingo Maeda
- Arrhythmia Advanced Therapy Center, AOI Universal Hospital, Kanagawa, Japan
| | | | - Yasuhide Tsuda
- Arrhythmia Advanced Therapy Center, AOI Universal Hospital, Kanagawa, Japan
| | - Ryo Yonai
- Cardiovascular Therapy Center, AOI Universal Hospital, Kawasaki, Japan
| | | | - Jackson J Liang
- Department of Cardiac Electrophysiology, University of Michigan, Ann Arbor, Michigan
| | - Ruben Casado Arroyo
- Department of Cardiology, Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Mihoko Kawabata
- Arrhythmia Advanced Therapy Center, AOI Universal Hospital, Kanagawa, Japan
| | | | - Kenzo Hirao
- Arrhythmia Advanced Therapy Center, AOI Universal Hospital, Kanagawa, Japan
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021; 85:1104-1244. [PMID: 34078838 DOI: 10.1253/circj.cj-20-0637] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center and Chugoku Cancer Center
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kaoru Okishige
- Department of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Yuji Nakazato
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi
| | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Inoue
- Division of Arrhythmia, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kikuya Uno
- Arrhythmia Center, Chiba Nishi General Hospital
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | | | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsugutoshi Suzuki
- Departments of Pediatric Electrophysiology, Osaka City General Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Department of Internal Medicine II, Kansai Medical University
| | - Masaomi Chinushi
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Nobuhiro Nishi
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | | | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital
| | - Tomoshige Morimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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Valderrábano M. Vein of Marshall ethanol infusion in the treatment of atrial fibrillation: From concept to clinical practice. Heart Rhythm 2021; 18:1074-1082. [PMID: 33781979 DOI: 10.1016/j.hrthm.2021.03.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/18/2021] [Accepted: 03/21/2021] [Indexed: 11/25/2022]
Abstract
The vein of Marshall (VOM) contains innervation, myocardial connections, and arrhythmogenic foci that make it an attractive target in catheter ablation of atrial fibrillation (AF). Additionally, it co-localizes with the mitral isthmus, which is critical to sustain perimitral flutter, and is a true atrial vein that communicates with underlying myocardium. Retrograde balloon cannulation of the VOM from the coronary sinus is feasible and allows for ethanol delivery, which results in rapid ablation of neighboring myocardium and its innervation. Here we review the body of work performed over a span of 13 years, from the inception of the technique, to its preclinical validation, to demonstration of its ablative and denervation effects, and finally to completion of a randomized clinical trial demonstrating favorable outcomes, improving rhythm control in catheter ablation of persistent AF.
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Affiliation(s)
- Miguel Valderrábano
- Division of Cardiac Electrophysiology, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center and Houston Methodist Research Institute, The Methodist Hospital, Houston, Texas.
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Okishige K, Kawaguchi N, Iwai S, Yamauchi Y, Keida T, Sasano T, Hirao K, Valderrabano M. Comparative Study of Cryoballoon versus Radiofrequency for Pulmonary Vein Isolation when Combined with vein of Marshall Ethanol Infusion for Paroxysmal Atrial Fibrillation. J Atr Fibrillation 2020; 12:2253. [PMID: 32435354 DOI: 10.4022/jafib.2253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 12/12/2019] [Accepted: 01/11/2020] [Indexed: 01/08/2023]
Abstract
Introduction Ethanol infusion (EI) in the vein of Marshall (VOM) has multifactorial effects that could be synergistic to pulmonary vein isolation (PVI) in ablation of atrial fibrillation (AF). The efficacy of radiofrequency (RF) versus cryoablation when combined with a VOM-EI has never been investigated. The aim of this study is to evaluate outcome differences of AF ablation using RF versus cryoablation when combined with a VOM-EI. Materials and Methods Consecutive patients (n=132) underwent catheter ablation of paroxysmal AF with either RF or cryoballoon (CB) for PVI combined with VOM-EI. Bi-directional conduction block at the mitral isthmus was attempted. The end-point was the freedom from any atrial arrhythmias documented after a blanking period of 90 days after the procedure. Results Kaplan-Meier estimates of the arrhythmia-free survival after 1 year were 63.8 (RF + VOM), and 82.7 % (CB + VOM), respectively. Comparison between CB + VOM versus RF + VOM reached a significance (p=0.0292). The periprocedural complication rate was comparable in both groups (5.0 % RF, 5.8 % CB; p=0.14) with a significant difference in the incidence of phrenic nerve palsy (0 % RF, 2.0 % CB; p<0.05). Conclusions PVI with a CB had an increased freedom from AF recurrence compared to RF combined with VOM-EI. The present results suggest a potential additive effect of a VOM-EI to CB application.
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Affiliation(s)
- Kaoru Okishige
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan.,Division of Cardiology, Edogawa Hospital.,Arrhythmia Center, Tokyo Medical and Dental University.,Division of Cardiac Electrophysiology, Methodist DeBakey Heart and Vascular Center and Houston Methodist Research Institute, Houston, TX
| | - Naohiko Kawaguchi
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan.,Division of Cardiology, Edogawa Hospital.,Arrhythmia Center, Tokyo Medical and Dental University.,Division of Cardiac Electrophysiology, Methodist DeBakey Heart and Vascular Center and Houston Methodist Research Institute, Houston, TX
| | - Shinsuke Iwai
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan.,Division of Cardiology, Edogawa Hospital.,Arrhythmia Center, Tokyo Medical and Dental University.,Division of Cardiac Electrophysiology, Methodist DeBakey Heart and Vascular Center and Houston Methodist Research Institute, Houston, TX
| | | | | | - Tetsuo Sasano
- Arrhythmia Center, Tokyo Medical and Dental University
| | - Kenzo Hirao
- Division of Cardiac Electrophysiology, Methodist DeBakey Heart and Vascular Center and Houston Methodist Research Institute, Houston, TX
| | - Miguel Valderrabano
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan.,Division of Cardiology, Edogawa Hospital.,Arrhythmia Center, Tokyo Medical and Dental University.,Division of Cardiac Electrophysiology, Methodist DeBakey Heart and Vascular Center and Houston Methodist Research Institute, Houston, TX
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8
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Okishige K, Shigeta T, Nishimura T, Nakamura RA, Hirao T, Yoshida H, Yamauchi Y, Keida T, Sasano T, Hirao K, Valderrábano M. Chemical mapping as a predictor of vein of Marshall ethanol ablative effects. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 43:47-53. [PMID: 31707738 DOI: 10.1111/pace.13839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/28/2019] [Accepted: 11/06/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to test regional pharmacological effects of an antiarrhythmic agents to predict ablative effects. BACKGROUND The vein of Marshall (VOM) providing vascular access to myocardial tissue has been used for ablative purposes using ethanol. METHODS A total of 35 patients (male 21, 63.2 ± 7.8 years old) were included. A balloon-tipped infusion catheter was inserted into the VOM. Endocardial ultrahigh-resolution mapping was performed along the VOM region to record the change in atrial electrograms (AEs) after VOM injection of cibenzoline of 3.5 mg during sustained atrial fibrillation (AF). Subsequently, ethanol was infused into the VOM and ablative region was mapped. RESULTS In 17 patients (49 %), cibenzoline reduced AEs amplitude by >50%, all of which had also complete elimination of AEs following ethanol (Group A). In 18 patients (Group B), cibenzoline failed to eliminate AEs; yet, in 13 of 18 AEs were eliminated by ethanol. In the remaining five patients, ethanol did not eliminate AE. CONCLUSIONS Cibenzoline into the VOM could reliably predicts the results of subsequent ethanol infusion into the VOM using ultrahigh-resolution mapping system, which leads to avoid unnecessary permanent lesion creation by ethanol infusion.
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Affiliation(s)
- Kaoru Okishige
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | - Takatoshi Shigeta
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | - Takuro Nishimura
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | - Rena A Nakamura
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | - Tatsuhiko Hirao
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | - Hiroshi Yoshida
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | - Yasuteru Yamauchi
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | - Takehiko Keida
- Department of Cardiology, Edogawa Hospital, Tokyo, Japan
| | - Tetsuo Sasano
- Arrhythmia Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenzo Hirao
- Arrhythmia Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Miguel Valderrábano
- Division of Cardiac Electrophysiology, Methodist DeBakey Heart and Vascular Center, Houston, Texas.,Division of Cardiac Electrophysiology, Houston Methodist Research Institute, Houston, Texas
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9
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Clinical impact of ethanol infusion into the vein of Marshall on the mitral isthmus area evaluated by atrial electrograms recorded inside the coronary sinus. Heart Rhythm 2019; 16:1030-1038. [DOI: 10.1016/j.hrthm.2019.01.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Indexed: 11/24/2022]
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10
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Liu C, Lo L, Lin Y, Lin C, Chang S, Chung F, Chao T, Hu Y, Tuan T, Liao J, Chen Y, Kuo L, Chang T, Hoang QM, Salim S, Vicera JJB, Wu C, Chuang C, Huang T, Chen S. Long‐term efficacy and safety of adjunctive ethanol infusion into the vein of Marshall during catheter ablation for nonparoxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2019; 30:1215-1228. [DOI: 10.1111/jce.13969] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 04/01/2019] [Accepted: 04/05/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Chih‐Min Liu
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| | - Li‐Wei Lo
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| | - Yenn‐Jiang Lin
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| | - Chin‐Yu Lin
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| | - Shih‐Lin Chang
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| | - Fa‐Po Chung
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| | - Tze‐Fan Chao
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| | - Yu‐Feng Hu
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| | - Ta‐Chuan Tuan
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| | - Jo‐Nan Liao
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| | - Yun‐Yu Chen
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Epidemiology and Preventive Medicine College of Public HealthNational Taiwan University Taipei Taiwan
| | - Ling Kuo
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| | - Ting‐Yung Chang
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| | - Quang Minh Hoang
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
| | - Simon Salim
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
| | - Jennifer Jeanne B. Vicera
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
| | - Cheng‐I Wu
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
| | - Chieh‐Mao Chuang
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
| | - Ting‐Chung Huang
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
| | - Shih‐Ann Chen
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Institute of Clinical Medicine, School of MedicineNational Yang‐Ming University Taipei Taiwan
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11
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Higa S, Lo LW, Chen SA. Catheter Ablation of Paroxysmal Atrial Fibrillation Originating from Non-pulmonary Vein Areas. Arrhythm Electrophysiol Rev 2018; 7:273-281. [PMID: 30588316 DOI: 10.15420/aer.2018.50.3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 11/16/2018] [Indexed: 02/04/2023] Open
Abstract
Pulmonary veins (PVs) are a major source of ectopic beats that initiate AF. PV isolation from the left atrium is an effective therapy for the majority of paroxysmal AF. However, investigators have reported that ectopy originating from non-PV areas can also initiate AF. Patients with recurrent AF after persistent PV isolation highlight the need to identify non-PV ectopy. Furthermore, adding non-PV ablation after multiple AF ablation procedures leads to lower AF recurrence and a higher AF cure rate. These findings suggest that non-PV ectopy is important in both the initiation and recurrence of AF. This article summarises current knowledge about the electrophysiological characteristics of non-PV AF, suitable mapping and ablation strategies, and the safety and efficacy of catheter ablation of AF initiated by ectopic foci originating from non-PV areas.
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Affiliation(s)
- Satoshi Higa
- Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital Okinawa, Japan
| | - Li-Wei Lo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital Taipei, Taiwan.,Institute of Clinical Medicine, Department of Medicine, School of Medicine, National Yang-Ming University Taipei, Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital Taipei, Taiwan.,Institute of Clinical Medicine, Department of Medicine, School of Medicine, National Yang-Ming University Taipei, Taiwan
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12
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Valderrábano M. Ligament of Marshall arrhythmogenesis and vein of Marshall ethanol: A problem with a solution. Heart Rhythm 2018; 15:25-27. [DOI: 10.1016/j.hrthm.2017.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Indexed: 10/18/2022]
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13
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Kato K, Igawa O, Morimoto SI, Kametani R, Tanaka A, Hattori H. Ethanol injection into the Marshall vein provoking a pericardial effusion resulting in a fatal complication in a patient with persistent atrial fibrillation. Clin Case Rep 2017; 5:1510-1515. [PMID: 28878915 PMCID: PMC5582217 DOI: 10.1002/ccr3.1076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 06/03/2017] [Accepted: 06/13/2017] [Indexed: 11/05/2022] Open
Abstract
An EIM (ethanol infusion into the vein of Marshall [VOM]) provoked a fatal complication in a chronic hemodialysis patient. Autopsy revealed a lacerated VOM covered with thrombi as the only potential cause. The EIM caused vascular damage and clots resulting in myocardial necrosis and interstitial bleeding around the lacerated VOM.
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Affiliation(s)
- Kazuo Kato
- Department of Cardiology Nagoya Tokushukai General Hospital Kasugai Japan
| | - Osamu Igawa
- Department of Internal Medicine Nihon Medical University Tokyo Japan
| | | | - Ryosuke Kametani
- Department of Cardiology Nagoya Tokushukai General Hospital Kasugai Japan
| | - Akimitsu Tanaka
- Department of Cardiology Nagoya Tokushukai General Hospital Kasugai Japan
| | - Hideo Hattori
- Department of Cardiology Nagoya Tokushukai General Hospital Kasugai Japan
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14
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Rodríguez-Mañero M, Schurmann P, Valderrábano M. Ligament and vein of Marshall: A therapeutic opportunity in atrial fibrillation. Heart Rhythm 2015; 13:593-601. [PMID: 26576705 DOI: 10.1016/j.hrthm.2015.10.018] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Moisés Rodríguez-Mañero
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research Institute, The Methodist Hospital, Houston, Texas
| | - Paul Schurmann
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research Institute, The Methodist Hospital, Houston, Texas
| | - Miguel Valderrábano
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research Institute, The Methodist Hospital, Houston, Texas.
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15
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Wongcharoen W, Lin YJ, Chang SL, Lo LW, Hu YF, Chung FP, Chong E, Chao TF, Tuan TC, Chang YT, Lin CY, Liao JN, Lin YC, Chen YY, Chen SA. History of hyperthyroidism and long-term outcome of catheter ablation of drug-refractory atrial fibrillation. Heart Rhythm 2015; 12:1956-62. [DOI: 10.1016/j.hrthm.2015.06.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Indexed: 11/28/2022]
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16
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Báez-Escudero JL, Keida T, Dave AS, Okishige K, Valderrábano M. Ethanol infusion in the vein of Marshall leads to parasympathetic denervation of the human left atrium: implications for atrial fibrillation. J Am Coll Cardiol 2014; 63:1892-901. [PMID: 24561151 DOI: 10.1016/j.jacc.2014.01.032] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 12/18/2013] [Accepted: 01/07/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study sought to determine whether ethanol infusion in the vein of Marshall (VOM) can ablate intrinsic cardiac nerves (ICN). BACKGROUND ICN cluster around the left atrial epicardium and are implicated in the genesis of atrial fibrillation (AF). METHODS Patients undergoing catheter AF ablation underwent adjunctive ethanol injection in the VOM. A multipolar catheter was introduced in the VOM and used for high-frequency stimulation (HFS), either as HFS with P-wave synchronized (SynchHFS), 30 pulses, 100 Hz (n = 8) or as HFS with 3 to 10 s bursts (BurstHFS), 33 Hz (n = 72) at 25 mA for 1-ms duration. Atrioventricular (AV) nodal conduction slowing (asystole >2 s or R-R interval prolongation >50%) and AF inducibility were assessed before and after VOM ethanol infusion. Up to 4 1-ml infusions of 98% ethanol were delivered via an angioplasty balloon in the VOM. RESULTS SynchHFS induced AF in 8 of 8 patients. In 4 of 8 AF initiated spontaneously without VOM capture. No parasympathetic responses were elicited by SynchHFS. BurstHFS was performed in 32 patients undergoing de novo AF ablation (Group 1) and 40 patients undergoing repeat ablation (Group 2). Parasympathetic responses were found in all 32 Group 1 patients and in 75% of Group 2 patients. After VOM ethanol infusion, parasympathetic responses were abolished in all patients (both groups). There were no acute complications related to VOM ethanol infusion. CONCLUSIONS The VOM contains ICN that connect with the AV node and can trigger AF. Retrograde ethanol infusion in the VOM reliably eliminates local ICN responses. The VOM is a vascular route for ICN-targeting therapies.
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Affiliation(s)
- José L Báez-Escudero
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research Institute, The Methodist Hospital, Houston, Texas
| | - Takehiko Keida
- Department of Cardiology, Edogawa Hospital, Tokyo, Japan
| | - Amish S Dave
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research Institute, The Methodist Hospital, Houston, Texas
| | | | - Miguel Valderrábano
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research Institute, The Methodist Hospital, Houston, Texas.
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