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Kewcharoen J, Shah K, Bhardwaj R, Contractor T, Ramsingh D, Turagam MK, Mandapati R, Lakkireddy D, Garg J. Catheter ablation for atrial fibrillation in patients with prior left atrial appendage occlusion device. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01914-8. [PMID: 39256235 DOI: 10.1007/s10840-024-01914-8] [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: 04/25/2024] [Accepted: 08/25/2024] [Indexed: 09/12/2024]
Abstract
BACKGROUND The safety and efficacy of CA for AF and left-sided atrial arrhythmias (AA) in patients with left atrial appendage occlusion (LAAO) devices are lacking. METHODS This is a single-center retrospective registry that included all patients with prior LAAO who underwent catheter ablation for AF or left-sided atrial arrhythmia from January 2020-January 2023. The primary outcomes were procedure-related complications, device-related complications, AA recurrence, and stroke. RESULTS A total of 30 patients with prior LAAO were included in the analysis (mean age 75.1 ± 7.1 years old, 50% male, mean CHA2DS2-VASc score 4 ± 1.6, 46.7% paroxysmal AF, 73.3% had prior AF ablation, mean time to ablation 475 ± 365 days). 93.3% (n = 28) and 6.6% (n = 2) patients had ablation for AF (46.7% paroxysmal, 36.7% persistent, 10% long-standing persistent) and left-sided atrial tachycardia, respectively. 16.7% (n = 5) patients underwent ablation along the left atrial appendage ostium, and 3.3% (n = 1) underwent Vein of Marshall alcohol ablation. There were 3 (10%) peri-procedural complications (1 access hematoma and two pericardial effusions requiring intervention-none related to left atrial appendage ostium or alcohol ablation). During the mean follow-up of 440 ± 379 days, 40% (n = 12) patients had AA recurrence (91.6% AF, 8.3% atrial tachycardia), of which five patients needed repeat ablation, and two patients were readmitted for heart failure. There was no stroke or any device-related complications, including new peri-device leaks or device-related thrombosis in patients who had follow-up imaging studies (n = 11, 36.7%). CONCLUSION Catheter ablation for AF (including VoM alcohol ablation) in patients with prior LAAO devices is feasible and safe with favorable outcomes.
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Affiliation(s)
- Jakrin Kewcharoen
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Kuldeep Shah
- Division of Cardiology, Cardiac Arrhythmia Service, MercyOne Siouxland Heart and Vascular Center, Sioux City, IA, USA
| | - Rahul Bhardwaj
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Tahmeed Contractor
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Davendra Ramsingh
- Division of Cardiac Anesthesiology, Loma Linda University Health, Loma Linda, CA, USA
| | - Mohit K Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ravi Mandapati
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | | | - Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA.
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Hasebe H, Furuyashiki Y, Yoshida K. Vein of Marshall chemical ablation decreases atrial fibrillation drivers detected by CARTOFINDER. J Cardiovasc Electrophysiol 2024; 35:1461-1470. [PMID: 38769635 DOI: 10.1111/jce.16311] [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: 02/19/2024] [Revised: 04/25/2024] [Accepted: 05/06/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION This study sought to elucidate the impact of vein of Marshall (VOM) chemical ablation on atrial fibrillation (AF) drivers by investigating the changes in CARTOFINDER mappings before and after VOM chemical ablation in patients with persistent AF. METHODS This study included 23 consecutive patients undergoing catheter ablation for long-persistent AF (>18 months). VOM chemical ablation was performed following pulmonary vein isolation. CARTOFINDER and AF cycle length (AFCL) maps were created in the left atrium (LA) before and after VOM chemical ablation. The LA was divided into 8 segments, and the number of focal activation points with 6 or more repetitions was counted in each segment. RESULTS The number of focal activation points was largest in the LA appendage (LAA). After VOM chemical ablation, the number of focal activation points in the LA decreased significantly (37 [interquartile range, IQR: 19-55] vs. 15 [IQR: 7-21], p < .001), and median AFCL was significantly prolonged (159 [147-168] vs. 164 [150-173] ms, p < .001). In the assessment of each segment, significant decreases in focal activation points were observed in the inferior, lateral, and anterior segments and LAA. Among the focal activation points disappearing after chemical ablation, the number in the non-ethanol-affected area was significantly larger than that in the affected area (13 [8-25] vs. 4 [1-10], p < .001). CONCLUSIONS VOM chemical ablation decreases AF drivers detected by CARTOFINDER. Mechanisms other than direct myocardial damage are considered to contribute the attenuation of AF drivers.
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Affiliation(s)
- Hideyuki Hasebe
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Arrhythmology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | | | - Kentaro Yoshida
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama, Japan
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Depes D, Mennander A, Immonen P, Mäkinen A, Huhtala H, Paavonen T, Kholová I. The autonomic nerves around the vein of Marshall: a postmortem study with clinical implications. APMIS 2024; 132:430-443. [PMID: 38468591 DOI: 10.1111/apm.13400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 01/31/2024] [Indexed: 03/13/2024]
Abstract
This study aims to analyze the vein of Marshall (VOM) in human autopsy hearts and its correlation with clinical data to elucidate the morphological substrates of atrial fibrillation (AF) and other cardiac diseases. Twenty-three adult autopsy hearts were studied, assessing autonomic nerves by immunohistochemistry with tyrosine hydroxylase (sympathetic nerves), choline acetyltransferase (parasympathetic nerves), growth-associated protein 43 (neural growth), and S100 (general neural marker) antibodies. Interstitial fibrosis was assessed by Masson trichrome staining. Measurements were conducted via morphometric software. The results were correlated with clinical data. Sympathetic innervation was abundant in all VOM-adjacent regions. Subjects with a history of AF, cardiovascular cause of death, and histologically verified myocardial infarction had increased sympathetic innervation and neural growth around the VOM at the mitral isthmus. Interstitial fibrosis increased with age and heart weight was associated with AF and cardiovascular cause of death. This study increases our understanding of the cardiac autonomic innervation in the VOM area in various diseases, offering implications for the development of new therapeutic approaches targeting the autonomic nervous system.
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Affiliation(s)
- Denis Depes
- Department of Pathology, Fimlab Laboratories, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ari Mennander
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Division of Cardiothoracic Surgery, Tampere University Heart Hospital, Tampere, Finland
| | - Paavo Immonen
- Department of Pathology, Fimlab Laboratories, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Artturi Mäkinen
- Department of Pathology, Fimlab Laboratories, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Timo Paavonen
- Department of Pathology, Fimlab Laboratories, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ivana Kholová
- Department of Pathology, Fimlab Laboratories, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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O’Neill L, De Becker B, De Smet M, Francois C, Tavernier R, Duytschaever M, Le Polain De Waroux JB, Knecht S. Vein of Marshall Ethanol Infusion for AF Ablation; A Review. J Clin Med 2024; 13:2438. [PMID: 38673710 PMCID: PMC11050818 DOI: 10.3390/jcm13082438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/14/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
The outcomes of persistent atrial fibrillation (AF) ablation are modest with various adjunctive strategies beyond pulmonary vein isolation (PVI) yielding largely disappointing results in randomised controlled trials. Linear ablation is a commonly employed adjunct strategy but is limited by difficulty in achieving durable bidirectional block, particularly at the mitral isthmus. Epicardial connections play a role in AF initiation and perpetuation. The ligament of Marshall has been implicated as a source of AF triggers and is known to harbour sympathetic and parasympathetic nerve fibres that contribute to AF perpetuation. Ethanol infusion into the Vein of Marshall, a remnant of the superior vena cava and key component of the ligament of Marshall, may eliminate these AF triggers and can facilitate the ease of obtaining durable mitral isthmus block. While early trials have demonstrated the potential of Vein of Marshall 'ethanolisation' to reduce arrhythmia recurrence after persistent AF ablation, further randomised trials are needed to fully determine the potential long-term outcome benefits afforded by this technique.
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Affiliation(s)
- Louisa O’Neill
- Department of Cardiology, AZ Sint-Jan Hospital, 8000 Bruges, Belgium; (B.D.B.); (S.K.)
- Department of Cardiology, Blackrock Clinic, A94 E4X7 Dublin, Ireland
- King’s College London, St. Thomas’ Hospital, London SE1 9NH, UK
| | - Benjamin De Becker
- Department of Cardiology, AZ Sint-Jan Hospital, 8000 Bruges, Belgium; (B.D.B.); (S.K.)
| | - Maarten De Smet
- Department of Cardiology, AZ Sint-Jan Hospital, 8000 Bruges, Belgium; (B.D.B.); (S.K.)
| | - Clara Francois
- Department of Cardiology, AZ Sint-Jan Hospital, 8000 Bruges, Belgium; (B.D.B.); (S.K.)
| | - Rene Tavernier
- Department of Cardiology, AZ Sint-Jan Hospital, 8000 Bruges, Belgium; (B.D.B.); (S.K.)
| | - Mattias Duytschaever
- Department of Cardiology, AZ Sint-Jan Hospital, 8000 Bruges, Belgium; (B.D.B.); (S.K.)
| | | | - Sebastien Knecht
- Department of Cardiology, AZ Sint-Jan Hospital, 8000 Bruges, Belgium; (B.D.B.); (S.K.)
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Takigawa M, Martin C, Jaïs P. Mechanisms of Vein of Marshall-Related Tachyarrhythmias and the Impact of Ethanol Infusion. Rev Cardiovasc Med 2024; 25:112. [PMID: 39076561 PMCID: PMC11264027 DOI: 10.31083/j.rcm2504112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/30/2023] [Accepted: 12/15/2023] [Indexed: 07/31/2024] Open
Abstract
The Ligament of Marshall (LOM) is a remnant of the embryonic sinus venosus and the left cardinal vein, containing a combination of fat, fibrous tissue, blood vessels, muscle bundles, nerve fibers, and ganglia. Various muscular connections exist between the LOM and the left atrium (LA) and the coronary sinus (CS). The LOM is richly innervated by autonomic nerves, with ganglion cells distributed around it. The unique characteristics of the LOM are responsible for generating focal electrical activities and enable it to serve as a substrate for micro- and macro-reentrant circuits. This, in turn, leads to the initiation and perpetuation of atrial fibrillation (AF) and atrial tachycardia (AT). Endocardial ablation in this region does not consistently succeed due to anatomical constraints within the left lateral LA, including the presence of a thicker and longer mitral isthmus (MI), anatomical variations between the MI and epicardial structures such as the CS and vein of Marshall (VOM) and circumflex artery, and the presence of fibrofatty tissue insulating the LOM. Furthermore, epicardial ablation is challenging for inexperienced institutions because of its invasive nature. Ethanol infusion into the VOM (EI-VOM) represents an effective and safe approach that can be employed in conjunction with radiofrequency ablation to eliminate this arrhythmogenic structure.
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Affiliation(s)
- Masateru Takigawa
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), 33000 Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, Univ. Bordeaux, 33000 Bordeaux, France
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 113-8510 Tokyo, Japan
- Department of Advanced Arrhythmia Research, Tokyo Medical and Dental University, 113-8510 Tokyo, Japan
| | - Claire Martin
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), 33000 Bordeaux, France
- Department of Cardiology, Royal Papworth Hospital, Papworth Road, CB2 0AY Cambridge, UK
- Department of Medicine, Cambridge University, CB2 1TN Cambridge, UK
| | - Pierre Jaïs
- Department of Cardiac Pacing and Electrophysiology, Bordeaux University Hospital (CHU), 33000 Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, Univ. Bordeaux, 33000 Bordeaux, France
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Liuba I, Santangeli P. The quest for achieving durable mitral isthmus block: probing the heights of the left lateral ridge. J Interv Card Electrophysiol 2024; 67:443-445. [PMID: 38109024 DOI: 10.1007/s10840-023-01693-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Ioan Liuba
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Pasquale Santangeli
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
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Zuo S, Sang C, Long D, Bo X, Lai Y, Guo Q, Wang Y, Li M, He L, Zhao X, Guo X, Liu N, Li S, Wang W, Jiang C, Tang R, Du X, Dong J, Ma C. Efficiency and Durability of EIVOM on Acute Reconnection After Mitral Isthmus Bidirectional Block. JACC Clin Electrophysiol 2024; 10:685-694. [PMID: 38658060 DOI: 10.1016/j.jacep.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 04/26/2024]
Abstract
BACKGROUND Reconnection after mitral isthmus (MI) block with radiofrequency ablation is common. OBJECTIVES The aim of this study was to investigate the effects of ethanol infusion in the vein of Marshall (EIVOM) on acute reconnection after MI bidirectional block. METHODS Patients with persistent atrial fibrillation who were scheduled to receive radiofrequency ablation for the first time were randomly assigned to the radiofrequency catheter ablation (RFCA) group (n = 44) or the EIVOM group (n = 45). The RFCA group's strategy was bilateral pulmonary vein ablation and linear ablation; in the EIVOM group, EIVOM was performed first. The primary endpoint was acute reconnection 30 minutes after MI bidirectional block. RESULTS A total of 89 patients (average age 62.9 years; 57.3% male) were enrolled. The average duration for persistent atrial fibrillation was 2.3 years. Before observation, all patients in the EIVOM group achieved MI bidirectional block (45 of 45 [100%]), compared with 84.1% (37 of 44) in the RFCA group. After the observation, 3 cases of MI reconnection occurred in the EIVOM group and 13 cases in the RFCA group (6.7% vs 35.1%; P < 0.05). After additional ablation, the final MI block rates in the EIVOM and RFCA groups were 97.8% (44 of 45) and 72.7% (32 of 44), respectively. During a 1-year follow-up, 8 of 45 patients who underwent EIVOM had recurrent atrial fibrillation, compared with 14 of 44 in the RFCA group (17.8% vs 31.8%; P < 0.01). CONCLUSIONS EIVOM can reduce acute reconnection after MI bidirectional block and significantly increase first-pass MI block.
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Affiliation(s)
- Song Zuo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Caihua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Deyong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xiaowen Bo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Yiwei Lai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Qi Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Yufeng Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Mengmeng Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Liu He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xueyuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Songnan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Wei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Chenxi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
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Ding X, Wang L, Liu Q, Chen S, Jiang R, Yu L, Zhang P, Lin J, Sun Y, Sheng X, Fu G, Zei PC, Jiang C. Use of intracardiac echocardiography in vein of Marshall ethanol infusion for ablation of persistent atrial fibrillation. Heart Rhythm 2024; 21:274-281. [PMID: 38103707 DOI: 10.1016/j.hrthm.2023.11.029] [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: 07/10/2023] [Revised: 11/25/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Few methods have been reported to demonstrate real-time effects during vein of Marshall (VOM) ethanol infusion in persistent atrial fibrillation (PeAF). OBJECTIVE This study was to evaluate the impact of left atrial (LA) monitoring using intracardiac echocardiography (ICE) during VOM ethanol infusion. METHODS Seventy-four consecutive patients with PeAF who underwent VOM ethanol infusion followed by radiofrequency (RF) ablation were included. Patients with findings on ICE consistent with echogenic streaming in the LA and with increased myocardial local echogenicity along the VOM area were placed into one group (group A) and those without into the other group (group B). Outcomes between the 2 groups were compared. RESULTS Forty-six patients (62%) were placed into group A. A new ethanol-induced low-voltage area in group A was larger than that in group B (8.5 cm2 [5.5-10.2 cm2] and 4.0 cm2 (2.4-6.3 cm2]; P < .001). The RF ablation time required to achieve MI block was reduced in group A patients (263.0 seconds [196.0-351.0 seconds] vs 417.0 seconds [315.0-709.5 seconds] in group B patients; P < .001). MI block was achieved in 46 patients (100%) via an endocardial approach in group A and 27 patients (96.4%) in group B (extra coronary sinus ablation in 4 patients). One patient developed clinically significant pericardial effusions and required pericardiocentesis in group B. CONCLUSION Presence of increased myocardial local echogenicity at the ridge and consistent echogenic streaming in the LA detected by ICE-based imaging during VOM ethanol infusion suggests increased ablated tissue in that region and lower RF ablation time during ablation for PeAF.
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Affiliation(s)
- Xueyan Ding
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, P.R. China
| | - Li Wang
- Department of Cardiology, Yongchuan Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Qiang Liu
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, P.R. China
| | - Shiquan Chen
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, P.R. China
| | - Ruhong Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, P.R. China
| | - Lu Yu
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, P.R. China
| | - Pei Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, P.R. China
| | - Jianwei Lin
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, P.R. China
| | - Yaxun Sun
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, P.R. China
| | - Xia Sheng
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, P.R. China
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, P.R. China
| | - Paul C Zei
- Department of Cardiac Electrophysiology and Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Chenyang Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, P.R. China.
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Lehmann HI, Chugh A. Alcohol ablation of the vein of Marshall in a patient with persistent atrial fibrillation and prior surgical ligation of the ligament of Marshall. HeartRhythm Case Rep 2024; 10:151-154. [PMID: 38404976 PMCID: PMC10885713 DOI: 10.1016/j.hrcr.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Affiliation(s)
- H. Immo Lehmann
- Jean and Samuel Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Aman Chugh
- Jean and Samuel Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
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Luo T, Chen Y, Xiong X, Cheng G, Deng C, Zhang J. Efficacy and safety of the vein of Marshall ethanol infusion with radiofrequency catheter ablation for the treatment of persistent atrial fibrillation in elderly patients. Front Cardiovasc Med 2023; 10:1276317. [PMID: 38130690 PMCID: PMC10733440 DOI: 10.3389/fcvm.2023.1276317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
Background Increasing age is a significant risk factor for atrial fibrillation (AF) recurrence after catheter ablation (CA). We accomplished this study to evaluate the efficacy and safety of the vein of Marshall (VOM) ethanol infusion (VOM-EI) with CA in elderly patients with persistent AF (PsAF). Methods This retrospective observational study included 360 consecutive adult patients with PsAF, of which 141 were in the Elder group (age ≥65 years) and 219 were in the Younger group (age <65 years), who underwent the VOM-EI and radiofrequency CA (RFCA) between May 2020 and April 2022. The efficacy endpoint was no recurrence of AF within one year after CA. Results The VOM-EI was successfully performed in 90.8% of patients from the Elder and 88.6% from the Younger group. All patients achieved PVI; 97.9% of patients from the Elder and 98.6% from the Younger group reached LA roof block, and 93.6% of patients from the Elder and 95.9% from the Younger group achieved MI block. There was no significant difference in 1-year survival without recurrence of AF between the two groups (83.0% and 84.5%, respectively). The incidence of complications within 30 days after the procedure from the two groups was low and did not differ significantly. Conclusion The VOM-EI combined with RFCA proved to be an effective and safe strategy for treating PsAF in elderly and younger patients.
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Affiliation(s)
| | | | | | | | | | - Jinlin Zhang
- Department of Cardiology, Wuhan Asian Heart Hospital, Wuhan, Hubei, China
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11
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Sirinvaravong N, Salmeron AW, Daoud EG, Houmsse M. Pro-arrhythmic Effect of the Vein of Marshall Ethanol Ablation: A Case Report of Perimitral Flutter After Vein of Marshall Ethanol Ablation. J Innov Card Rhythm Manag 2023; 14:5676-5680. [PMID: 38155724 PMCID: PMC10752430 DOI: 10.19102/icrm.2023.14122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/19/2023] [Indexed: 12/30/2023] Open
Abstract
The ligament of Marshall is an embryological remnant of the left superior vena cava that contains neural tissues shown to be an arrhythmogenic source of atrial fibrillation (AF). Vein of Marshall (VOM) ethanol ablation is an ablation technique that can potentially treat AF by targeting the ligament of Marshall. We report a case of a patient who developed a pro-arrhythmic effect related to VOM ethanol ablation, which manifested as a perimitral flutter.
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Affiliation(s)
| | | | - Emile G. Daoud
- Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - Mahmoud Houmsse
- Wexner Medical Center, Ohio State University, Columbus, OH, USA
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12
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Cerantola M, Hanumanthu BKJ, Hyman MC. Ablation of perimitral flutter in a patient with a partially inaccessible left atrium. HeartRhythm Case Rep 2023; 9:704-708. [PMID: 38047205 PMCID: PMC10691951 DOI: 10.1016/j.hrcr.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Affiliation(s)
- Maxime Cerantola
- Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Balaram Krishna J. Hanumanthu
- Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew C. Hyman
- Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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13
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De Lurgio DB. Selection of patients for hybrid ablation procedure. J Cardiovasc Electrophysiol 2023; 34:2179-2187. [PMID: 37003267 DOI: 10.1111/jce.15901] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/07/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023]
Abstract
Catheter ablation for treatment of symptomatic non-paroxysmal atrial fibrillation remains challenging. Clinical failure and need for continued medical therapy or repeat ablation is common, especially in more advanced forms of atrial fibrillation. Hybrid ablation has emerged as a more effective and safe therapy than endocardial-only ablation particularly for longstanding persistent atrial fibrillation as demonstrated by the randomized controlled CONVERGE trial. Hybrid ablation requires collaboration of electrophysiologists and cardiac surgeons to develop specific workflows. This review describes the Hybrid Convergent approach in the context of available ablation options and offers guidance for workflow development and patient selection.
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Affiliation(s)
- David B De Lurgio
- Emory St. Joseph's Hospital Suite 300, Emory University, Atlanta, Georgia, USA
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14
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Karatela MF, Fudim M, Mathew JP, Piccini JP. Neuromodulation therapy for atrial fibrillation. Heart Rhythm 2023; 20:100-111. [PMID: 35988908 DOI: 10.1016/j.hrthm.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/07/2022] [Accepted: 08/12/2022] [Indexed: 02/08/2023]
Abstract
Atrial fibrillation has a multifactorial pathophysiology influenced by cardiac autonomic innervation. Both sympathetic and parasympathetic influences are profibrillatory. Innovative therapies targeting the neurocardiac axis include catheter ablation or pharmacologic suppression of ganglionated plexi, renal sympathetic denervation, low-level vagal stimulation, and stellate ganglion blockade. To date, these therapies have variable efficacy. As our understanding of atrial fibrillation and the cardiac nervous system expands, our approach to therapeutic neuromodulation will continue evolving for the benefit of those with AF.
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Affiliation(s)
- Maham F Karatela
- Cardiac Electrophysiology Section, Duke Heart Center and Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Marat Fudim
- Cardiac Electrophysiology Section, Duke Heart Center and Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Joseph P Mathew
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Jonathan P Piccini
- Cardiac Electrophysiology Section, Duke Heart Center and Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
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15
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Langmuur SJJ, Taverne YJHJ, van Schie MS, Bogers AJJC, de Groot NMS. Optimization of intra-operative electrophysiological localization of the ligament of Marshall. Front Cardiovasc Med 2022; 9:1030064. [PMID: 36407441 PMCID: PMC9669368 DOI: 10.3389/fcvm.2022.1030064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Background The ligament of Marshall (LOM) may play a role in the pathophysiology of several tachyarrhythmias and accurate electrophysiological localization of this structure is crucial for effective ablation therapy. This study therefore quantifies electrophysiological properties of the LOM, and identifies which electrogram (EGM) recording (uni- or bipolar) and processing technologies [local activation time (LAT) and/or voltage mapping] are most suitable for accurate localization of the LOM. Methods The LOM was electrophysiologically identified in 19 patients (mean age 66 ± 14 years; 12 male) undergoing elective cardiac surgery using intra-operative high-density epicardial mapping, to quantify and visualize EGM features during sinus rhythm. Results Only a third of LOM potentials that were visualized using unipolar EGMs, were still visible in bipolar activation maps. Unipolar LOM potentials had lower voltages (P50: LOM: 1.51 (0.42–4.29) mV vs. left atrium (LA): 8.34 (1.50–17.91) mV, p < 0.001), less steep slopes (P50: LOM: –0.48 (–1.96 to –0.17) V/s vs. LA: –1.24 (–2.59 to –0.21) V/s, p < 0.001), and prolonged activation duration (LOM: 20 (7.5–30.5) ms vs. LA: 16.5 (6–28) ms, p = 0.008) compared to LA potentials. Likewise, bipolar LOM voltages were also smaller (P50: LOM: 1.54 (0.48–3.28) mV vs. LA: 3.12 (0.50–7.19) mV, p < 0.001). Conclusion The LOM was most accurately localized in activation and voltage maps by using unipolar EGMs with annotation of primary deflections in case of single potentials and secondary deflections in case of double or fractionated potentials.
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Affiliation(s)
- Sanne J. J. Langmuur
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | | | | | - Ad J. J. C. Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - Natasja M. S. de Groot
- Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
- *Correspondence: Natasja M. S. de Groot,
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16
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He B, Zhao F, Yu W, Li Y, Wu X, Lu Z. Ethanol Infusion of Vein of Marshall for the Treatment of Persistent Atrial Fibrillation: The Basics and Clinical Practice. J Cardiovasc Dev Dis 2022; 9:jcdd9080270. [PMID: 36005434 PMCID: PMC9409861 DOI: 10.3390/jcdd9080270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/21/2022] Open
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.
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Affiliation(s)
- Bo He
- Department of Cardiology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan 430071, China
| | - Fang Zhao
- Department of Cardiology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan 430071, China
| | - Wenxi Yu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan 430071, China
| | - Yi Li
- Department of Cardiology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan 430071, China
| | - Xiaoyan Wu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan 430071, China
| | - Zhibing Lu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071, China
- Cardiovascular Institute, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Institute of Myocardial Injury and Repair, Wuhan University, Wuhan 430071, China
- Correspondence: ; Tel.: +86-27-67813073
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17
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Akhtar Z, Sohal M, Kontogiannis C, Harding I, Zuberi Z, Bajpai A, Norman M, Pearse S, Beeton I, Gallagher MM. Anatomical variations in Coronary Venous Drainage: Challenges and Solutions in Delivering Cardiac Resynchronisation Therapy. J Cardiovasc Electrophysiol 2022; 33:1262-1271. [PMID: 35524414 DOI: 10.1111/jce.15524] [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: 02/21/2022] [Revised: 04/20/2022] [Accepted: 05/03/2022] [Indexed: 11/27/2022]
Abstract
AIMS To investigate the abnormalities of the coronary venous system in candidates for cardiac resynchronization therapy (CRT) and describe methods for circumventing the resulting difficulties. METHODS From 4 implanting institutes, data of all CRT implants between October 2008-October 2020 were screened for abnormal cardiac venous anatomy, defined as an anatomical variation not conforming to the accepted 'normal' anatomy. Patient demographics, procedural detail and subsequent left ventricle (LV) lead pacing indices were collected. RESULTS From a total of 3548 CRT implants, 15 (0.42%) patients (80% male) of 72.2±10.6 years in age with a LV ejection fraction of 34±10.3% were identified to have had an abnormal cardiac venous anatomy over the study period. There were 13 cases of persistent left side superior vena cava (pLSVC), 5 of which had coronary sinus ostium atresia (CSOA) including 2 with an 'unroofed' coronary sinus (CS); 1 patient had a unique anomalous origin of the CS and 1 patient had an isolated CSOA. In total 14 patients (60% repeat attempt) had successful percutaneous implant under general anaesthesia (46.7%) via the cephalic vein (59.1%), using the femoral approach (53.3%) for levophase venography and/or pull-through, including 1 case of endocardial LV implant. Pacing follow-up over 37.64±37.6 months demonstrated LV lead threshold between 0.62-2.9 volts (pulsewidth 0.4-1.5 milliseconds) in all cases; 5 patients died within 2.92±1.6 years of successful implant. CONCLUSION CRT devices can be implanted percutaneously even in the presence of substantial abnormalities of coronary venous anatomy. Alternative routes of venous access may be required. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Zaki Akhtar
- Department of Cardiology, St George's University Hospital, London, UK.,Department of Cardiology, Ashford and St Peter's Hospital, Surrey, UK
| | - Manav Sohal
- Department of Cardiology, St George's University Hospital, London, UK
| | | | - Idris Harding
- Department of Cardiology, St George's University Hospital, London, UK
| | - Zia Zuberi
- Department of Cardiology, St George's University Hospital, London, UK.,Department of Cardiology, Royal Surrey County Hospital, Guildford, UK
| | - Abhay Bajpai
- Department of Cardiology, St George's University Hospital, London, UK
| | - Mark Norman
- Department of Cardiology, St George's University Hospital, London, UK.,Department of Cardiology, Frimley Park Hospital, Surrey, UK
| | - Simon Pearse
- Department of Cardiology, St George's University Hospital, London, UK
| | - Ian Beeton
- Department of Cardiology, Ashford and St Peter's Hospital, Surrey, UK
| | - Mark M Gallagher
- Department of Cardiology, St George's University Hospital, London, UK.,Department of Cardiology, Ashford and St Peter's Hospital, Surrey, UK
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18
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Innovations in atrial fibrillation ablation. J Interv Card Electrophysiol 2022; 66:737-756. [PMID: 35411440 DOI: 10.1007/s10840-022-01215-y] [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: 01/28/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Catheter-based ablation to perform pulmonary vein isolation (PVI) has established itself as a mainstay in the rhythm control strategy of atrial fibrillation. This review article aims to provide an overview of recent advances in atrial fibrillation ablation technology. METHODS We reviewed the available literature and clinical trials of innovations in atrial fibrillation ablation technologies including ablation catheter designs, alternative energy sources, esophageal protection methods, electroanatomical mapping, and novel ablation targets. RESULTS Innovative radiofrequency (RF) catheter designs maximize energy delivery while avoiding overheating associated with conventional catheters. Single-shot balloon catheters in the form of cryoballoons, radiofrequency, and laser balloons have proven effective at producing pulmonary vein isolation and improving procedural efficiency and reproducibility. Pulsed field ablation (PFA) is a highly anticipated novel nonthermal energy source under development, which demonstrates selective ablation of the myocardium, producing durable lesions while also minimizing collateral damage. Innovative devices for esophageal protection including esophageal deviation and cooling devices have been developed to reduce esophageal complications. Improved electroanatomical mapping systems are being developed to help identify additional non-pulmonary triggers, which may benefit from ablation, especially with persistent atrial fibrillation. Lastly, the vein of Marshall alcohol ablation has been recently studied as an adjunct therapy for improving outcomes with catheter ablation for persistent atrial fibrillation. CONCLUSIONS Numerous advances have been made in the field of atrial fibrillation ablation in the past decade. While further long-term data is still needed for these novel technologies, they show potential to improve procedural efficacy and safety.
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19
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Fukuda K, Takada T, Satake H, Aizawa K, Miki K, Shimojyo T, Sato K, Ikeda S, Takeda M, Shiba N. Unique Left Pulmonary Vein Isolation in Straight Common Trunk Based on Longitudinal Conduction of Left Lateral Ridge. Pacing Clin Electrophysiol 2022; 45:598-604. [PMID: 35353402 DOI: 10.1111/pace.14476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/23/2022] [Accepted: 02/13/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND A left common pulmonary vein (LCPV) is the most common anatomical variation in the pulmonary vein (PV) and often influences strategies of PV isolation for atrial fibrillation (AF). Our objective was to elucidate the electrical properties of the specific shape of LCPV and to apply it to an ablation procedure. METHODS AND RESULTS We investigated consecutive 12 out of 204 paroxysmal AF patients who had the shape of a straight common trunk in LCPV defined by the formation of a single conduit with parallel cranial and caudal walls after the coalescence of superior and inferior pulmonary veins on the distal side. The distance between the top of the bifurcation of LPVs and the level coinciding with the middle of the anterior wall of LCPV (left lateral ridge: LLR) was more than 10 mm in all the patients. The activation pattern of the LLR showed longitudinal conduction without outside connections. All the LCPV except one were successfully isolated without ablating the LLR (C-shape ablation). Only one patient had AF recurrence during the follow-up period. CONCLUSION The LLR in LCPV with a straight common trunk has longitudinal conduction without outside connections, which permits the isolation of LCPV without ablating LLR. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Koji Fukuda
- Department of Cardiology, International University Health and Welfare Hospital, Nasushiobara, Japan
| | - Tsuyoshi Takada
- Department of Cardiology, International University Health and Welfare Hospital, Nasushiobara, Japan
| | - Hiroyuki Satake
- Department of Cardiology, International University Health and Welfare Hospital, Nasushiobara, Japan
| | - Kentaro Aizawa
- Department of Cardiology, International University Health and Welfare Hospital, Nasushiobara, Japan
| | - Keita Miki
- Department of Cardiology, International University Health and Welfare Hospital, Nasushiobara, Japan
| | - Takuya Shimojyo
- Department of Radiology(RT: Radiological technologist), International University Health and Welfare Hospital, Nasushiobara, Japan
| | - Koichi Sato
- Department of Cardiology, International University Health and Welfare Hospital, Nasushiobara, Japan
| | - Shohei Ikeda
- Department of Cardiology, International University Health and Welfare Hospital, Nasushiobara, Japan
| | - Morihiko Takeda
- Department of Cardiology, International University Health and Welfare Hospital, Nasushiobara, Japan
| | - Nobuyuki Shiba
- Department of Cardiology, International University Health and Welfare Hospital, Nasushiobara, Japan
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20
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Rodríguez-Mañero M, Martínez-Sande JL, García-Seara J, González-Ferrero T, González-Juanatey JR, Schurmann P, Tavares L, Valderrábano M. Neuromodulatory Approaches for Atrial Fibrillation Ablation. Eur Cardiol 2022; 16:e53. [PMID: 35024055 PMCID: PMC8728882 DOI: 10.15420/ecr.2021.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/23/2021] [Indexed: 12/01/2022] Open
Abstract
In this review, the authors describe evolving alternative strategies for the management of AF, focusing on non-invasive and percutaneous autonomic modulation. This modulation can be achieved – among other approaches – via tragus stimulation, renal denervation, cardiac afferent denervation, alcohol injection in the vein of Marshall, baroreceptor activation therapy and endocardial ganglionated plexi ablation. Although promising, these therapies are currently under investigation but could play a role in the treatment of AF in combination with conventional pulmonary vein isolation in the near future.
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Affiliation(s)
- Moisés Rodríguez-Mañero
- Department of Cardiology, University Hospital of Santiago de Compostela, Santiago de Compostela, A Coruña Galicia, Spain.,Institute of Health Research, University of Santiago de Compostela, Santiago de Compostela, A Coruña Galicia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) Spain
| | - Jose Luis Martínez-Sande
- Department of Cardiology, University Hospital of Santiago de Compostela, Santiago de Compostela, A Coruña Galicia, Spain.,Institute of Health Research, University of Santiago de Compostela, Santiago de Compostela, A Coruña Galicia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) Spain
| | - Javier García-Seara
- Department of Cardiology, University Hospital of Santiago de Compostela, Santiago de Compostela, A Coruña Galicia, Spain.,Institute of Health Research, University of Santiago de Compostela, Santiago de Compostela, A Coruña Galicia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) Spain
| | - Teba González-Ferrero
- Department of Cardiology, University Hospital of Santiago de Compostela, Santiago de Compostela, A Coruña Galicia, Spain
| | - José Ramón González-Juanatey
- Department of Cardiology, University Hospital of Santiago de Compostela, Santiago de Compostela, A Coruña Galicia, Spain.,Institute of Health Research, University of Santiago de Compostela, Santiago de Compostela, A Coruña Galicia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) Spain
| | - Paul Schurmann
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research Institute, The Methodist Hospital Houston, TX, US
| | - Liliana Tavares
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research Institute, The Methodist Hospital Houston, TX, US
| | - Miguel Valderrábano
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research Institute, The Methodist Hospital Houston, TX, US
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21
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张 科, 陈 鑫. [Safety and Medium- and Long-Term Efficacy of Treating Atrial Fibrillation with Surgical Radiofrequency Ablation during Concomitant Mitral Valve Surgery]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2021; 52:1022-1027. [PMID: 34841772 PMCID: PMC10408831 DOI: 10.12182/20211160503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the safety and medium- and long-term efficacy of surgical radiofrequency ablation to treat atrial fibrillation during concomitant mitral valve surgery. METHODS From January 2014 to December 2018, 280 patients with mitral valve disease and the comorbidity of preoperative atrial fibrillation were recruited for the study. Among them, 130 patients received only mitral valve surgery (non-ablation group), and 150 patients were underwent surgical radiofrequency ablation for the atrial fibrillation during concomitant mitral valve surgery (ablation group). Among the 150 patients of the ablation group, 80 had biatrial ablation, and 70 had left atrial ablation. Under general anesthesia, median sternotomy was done on all patients and cardiopulmonary bypass was established through the ascending aorta and superior and inferior venae cavae. After aortic occlusion, patients in the ablation group underwent the ablation procedure with the Atricure® bipolar ablation device, using the Cox Maze Ⅲ procedure as a reference. In addition, the left atrial appendage was removed and electrocautery of the ligament of Marshall and Waterston's groove were performed in all Cox Maze cases. Following ablation, mitral valve replacement or repair was performed. All patients were given 200 mg oral amiodarone on the first day after surgery, for three times/d×7 d, which was followed by twice/d×7 d, and then oral amiodarone 200 mg/d was maintained till the end of 3 months after surgery (ablation group) or 12 months after surgery (non-ablation group). Patients were followed up at the intervals of 3 months, 6 months, 12 months, 2 years, 3 years, and 5 years after discharge. The follow-up service included standard 12-lead chest electrocardiogram (ECG) and 24-h dynamic ECG. The primary end point of the study was the time point of postoperative atrial fibrillation and the secondary endpoints were major cardiovascular events, death, and readmission due to heart failure. RESULTS The surgeries were successfully performed in all subjects of the study. A total of 30 patients were lost to follow-up within 5 years after operation (10.7% losses to follow-up), including 11 patients in the ablation group and 19 patients in the non-ablation group. The proportion of patients who did not have atrial fibrillation in the ablation group and the non-ablation group at 6 months, 12 months, 2 years, 3 years and 5 years after surgery was 83.3% and 27.7%, 72.7% and 20.8%, 66.0% and 15.4% 61.3% and 13.1%, and 43.3% and 10.8%, respectively, with the data from the two groups showing statistically significant difference ( P<0.001). The proportion of patients who did not have atrial fibrillation in the biatrial ablation and the left atrial ablation group at 6 months, 12 months, 2 years, 3 years and 5 years after surgery was 87.3% and 87.5%, 92.4% and 82.8%, 90.5% and 85.7%, 94.8% and 88.1%, and 75.5% and 69.4%%, respectively, with the data from the two groups showing no statistically significant difference ( P>0.05). However, the cumulative incidence of atrial fibrillation in the two groups showed statistically significant difference ( P<0.001). There were no deaths within 30 days after operation in either group. There was no significant difference in cerebrovascular accident, readmission for heart failure, pulmonary infection and mediastinal infection between the two groups within one year after operation ( P>0.05). However, the proportion of patients who had permanent pacemaker installed due to Ⅲ-degree atrioventricular block in the ablation group was higher than that in the non-ablation group ( P<0.05). The proportion of patients who required re-drainage due to delayed pericardial effusion in the ablation group was higher than that in the non-ablation group ( P<0.05). CONCLUSION In the group of patients who had modified Cox Maze procedure with bipolar ablation device to treat atrial fibrillation during concomitant mitral valve surgery, the maintenance rate of sinus rhythm after cardioversion was significantly higher than that in the non-ablation group. The surgery showed better safety and significantly better medium- and long-term outcomes. Left atrial ablation and biatrial ablation were both considered safe and effective surgical treatment for atrial fibrillation. Compared with the left atrial ablation group, the biatrial ablation group achieved better effects in restoring and maintaining sinus rhythm without an increase the incidence of perioperative complications.
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Affiliation(s)
- 科 张
- 南京医科大学附属南京医院 南京市第一医院 心胸外科 (南京 210006)Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - 鑫 陈
- 南京医科大学附属南京医院 南京市第一医院 心胸外科 (南京 210006)Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
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22
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Zandstra TE, Notenboom RGE, Wink J, Kiès P, Vliegen HW, Egorova AD, Schalij MJ, De Ruiter MC, Jongbloed MRM. Asymmetry and Heterogeneity: Part and Parcel in Cardiac Autonomic Innervation and Function. Front Physiol 2021; 12:665298. [PMID: 34603069 PMCID: PMC8481575 DOI: 10.3389/fphys.2021.665298] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 08/26/2021] [Indexed: 11/17/2022] Open
Abstract
The cardiac autonomic nervous system (cANS) regulates cardiac adaptation to different demands. The heart is an asymmetrical organ, and in the selection of adequate treatment of cardiac diseases it may be relevant to take into account that the cANS also has sidedness as well as regional differences in anatomical, functional, and molecular characteristics. The left and right ventricles respond differently to adrenergic stimulation. Isoforms of nitric oxide synthase, which plays an important role in parasympathetic function, are also distributed asymmetrically across the heart. Treatment of cardiac disease heavily relies on affecting left-sided heart targets which are thought to apply to the right ventricle as well. Functional studies of the right ventricle have often been neglected. In addition, many principles have only been investigated in animals and not in humans. Anatomical and functional heterogeneity of the cANS in human tissue or subjects is highly valuable for understanding left- and right-sided cardiac pathology and for identifying novel treatment targets and modalities. Within this perspective, we aim to provide an overview and synthesis of anatomical and functional heterogeneity of the cANS in tissue or subjects, focusing on the human heart.
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Affiliation(s)
- Tjitske E. Zandstra
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Jeroen Wink
- Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands
| | - Philippine Kiès
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Hubert W. Vliegen
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Martin J. Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Marco C. De Ruiter
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Monique R. M. Jongbloed
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
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23
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Martínez Urabayen U, Caballeros M, Soriano I, Ramos P, García Bolao I, Bastarrika G. Características anatómicas de la aurícula izquierda en sujetos sometidos a ablación por radiofrecuencia de fibrilación auricular. RADIOLOGIA 2021. [DOI: 10.1016/j.rx.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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24
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De Martino G, Compagnucci P, Mancusi C, Vassallo E, Calvanese C, Della Ratta G, Librera M, Franciulli M, Marino L, Russo AD, Casella M. Stepwise endo-/epicardial catheter ablation for atrial fibrillation: The Mediterranea approach. J Cardiovasc Electrophysiol 2021; 32:2107-2115. [PMID: 34216076 PMCID: PMC8457187 DOI: 10.1111/jce.15151] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/28/2021] [Accepted: 06/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Outcomes of catheter ablation (CA) among patients with nonparoxysmal atrial fibrillation (AF) are largely disappointing. OBJECTIVE We sought to evaluate the feasibility, effectiveness, and safety of a single-stage stepwise endo-/epicardial approach in patients with persistent/longstanding-persistent AF. METHODS We enrolled 25 consecutive patients with symptomatic persistent (n = 4) or longstanding-persistent (n = 21) AF and at least one prior endocardial procedure, who underwent CA using an endo-/epicardial approach. Our anatomical stepwise protocol included multiple endocardial as well as epicardial (Bachmann's bundle [BB] and ligament of Marshall ablations) components, and entailed ablation of atrial tachycardias emerging during the procedure. The primary outcome was freedom from any AF/atrial tachycardia episode after a 3-month blanking period. The secondary outcome was patients' symptom status during follow-up. RESULTS The stepwise endo-/epicardial approach allowed sinus rhythm restoration in 72% of patients, either directly (n = 6, 24%) or after AF organization into atrial tachycardia (n = 12, 48%). BB's ablation was commonly implicated in arrhythmia termination. After a median follow-up of 266 days (interquartile range, 96 days), survival free from AF/atrial tachycardia was 88%. Antiarrhythmic drugs could be discontinued in 22 patients (88%). As compared to baseline, more patients were asymptomatic at 9-month follow-up (0% vs. 56%, p = .02). Five patients (20%) developed mild medical complications, whereas one subject (4%) had severe kidney injury requiring dialysis. CONCLUSION A single-stage endo-/epicardial CA resulted in favorable rhythm and symptom outcomes in a cohort of patients with symptomatic persistent/longstanding-persistent AF and one or more prior endocardial procedures. Epicardial ablation of BB was commonly implicated in procedural success.
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Affiliation(s)
| | - Paolo Compagnucci
- Department of Biomedical Sciences and Public Health, Cardiology and Arrhythmology ClinicUniversity Hospital “Ospedali Riuniti”, Marche Polytechnic UniversityAnconaItaly
| | - Carmine Mancusi
- Arrhythmology and Heart Failure UnitMediterranea HospitalNaplesItaly
| | - Enrico Vassallo
- Arrhythmology and Heart Failure UnitMediterranea HospitalNaplesItaly
| | - Claudia Calvanese
- Arrhythmology and Heart Failure UnitMediterranea HospitalNaplesItaly
| | | | | | | | - Luigi Marino
- Cardiac Surgery UnitMediterranea HospitalNaplesItaly
| | - Antonio Dello Russo
- Department of Biomedical Sciences and Public Health, Cardiology and Arrhythmology ClinicUniversity Hospital “Ospedali Riuniti”, Marche Polytechnic UniversityAnconaItaly
| | - Michela Casella
- Department of Clinical, Special, and Dental Sciences, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti”Marche Polytechnic UniversityAnconaItaly
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Liang JJ, Bogun F. Coronary Venous Mapping and Catheter Ablation for Ventricular Arrhythmias. Methodist Debakey Cardiovasc J 2021; 17:13-18. [PMID: 34104315 PMCID: PMC8158455 DOI: 10.14797/huzr1007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Catheter ablation is an effective treatment method for ventricular arrhythmias (VAs). These arrhythmias can often be mapped and targeted with ablation from the left and right ventricular endocardium. However, in some situations the VA site of origin or substrate may be intramural or epicardial in nature. In these cases, the coronary venous system (CVS) provides an effective vantage point for mapping and ablation. This review highlights situations in which CVS mapping may be helpful and discusses techniques for CVS mapping and ablation.
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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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27
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Lador A, Valderrábano M. Atrial Fibrillation Ablation Using Vein of Marshall Ethanol Infusion. Methodist Debakey Cardiovasc J 2021; 17:52-55. [PMID: 34104321 DOI: 10.14797/zqme8581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Catheter ablation has become a cornerstone treatment for atrial fibrillation (AF). Pulmonary vein isolation is the accepted approach for paroxysmal AF ablation, but it is less effective for persistent AF. The vein of Marshall (VOM) is located in the epicardial left atrium and can be a source of AF triggers as well as a tract for autonomic nerves. It directly communicates with the underlying myocardium, including the left atrial ridge and the posterior mitral isthmus. This review discusses the latest evidence regarding the mechanisms, procedural aspects, and outcomes of VOM ethanol infusion when used as an adjunct to pulmonary vein isolation in patients with persistent AF.
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Affiliation(s)
- Adi Lador
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Miguel Valderrábano
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
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Derval N, Duchateau J, Denis A, Ramirez FD, Mahida S, André C, Krisai P, Nakatani Y, Kitamura T, Takigawa M, Chauvel R, Tixier R, Pillois X, Sacher F, Hocini M, Haïssaguerre M, Jaïs P, Pambrun T. Marshall bundle elimination, Pulmonary vein isolation, and Line completion for ANatomical ablation of persistent atrial fibrillation (Marshall-PLAN): Prospective, single-center study. Heart Rhythm 2020; 18:529-537. [PMID: 33383226 DOI: 10.1016/j.hrthm.2020.12.023] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Beyond pulmonary vein isolation (PVI), the optimal ablation strategy for persistent atrial fibrillation (AF) remains poorly defined. OBJECTIVE The purpose of this study was to examine a novel comprehensive ablation strategy (Marshall bundle elimination, Pulmonary vein isolation, and Line completion for ANatomical ablation of persistent atrial fibrillation [Marshall-PLAN]) strictly based on anatomical considerations. METHODS Left atrial (LA) sites were sequentially targeted as follows: (1) coronary sinus and vein of Marshall (CS-VOM) musculature; (2) PVI; and (3) anatomical isthmuses (mitral, roof, and cavotricuspid isthmus [CTI]). The primary endpoint was 12-month freedom from AF/atrial tachycardia (AT). RESULTS Seventy-five consecutive patients were included (age 61 ± 9 years; 10 women; AF duration 9 ± 11 months; mean LA volume 197 ± 43 mL). VOM ethanol infusion was completed in 69 patients (92%). The full Marshall-PLAN lesion set (VOM, PVI, mitral, roof, and CTI with block) was successfully completed in 68 patients (91%). At 12 months, 54 of 75 patients (72%) were free from AF/AT after a single procedure (no antiarrhythmic drugs) in the overall cohort. In the subset of patients with a complete Marshall-PLAN lesion set (n = 68), the single procedure success rate was 79%. After 1 or 2 procedures, 67 of 75 patients (89%) remained free from AF/AT (no antiarrhythmic drugs). After 1 or 2 procedures, VOM ethanol infusion was complete in 72 of 75 patients (96%). CONCLUSION A novel ablation strategy that systematically targets anatomical atrial structures (VOM ethanol infusion, PVI, and prespecified linear lesions) is feasible, safe, and associated with a high rate of freedom from arrhythmia recurrence at 12 months in patients with persistent AF.
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Affiliation(s)
- Nicolas Derval
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France.
| | - Josselin Duchateau
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Arnaud Denis
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France
| | - F Daniel Ramirez
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France
| | - Saagar Mahida
- Liverpool Centre for Cardiovascular Science and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Clémentine André
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France
| | - Philipp Krisai
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France
| | - Yosuke Nakatani
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France
| | - Takeshi Kitamura
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France
| | - Masateru Takigawa
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France
| | - Remi Chauvel
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France
| | - Romain Tixier
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France
| | - Xavier Pillois
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Frédéric Sacher
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Michel Haïssaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Pierre Jaïs
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France
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Identification and Endocardial Ablation of the Ligament of Marshall for Pulmonary Vein Isolation. JACC Clin Electrophysiol 2020; 7:283-291. [PMID: 33736749 DOI: 10.1016/j.jacep.2020.08.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aims of this study were to establish criteria for identifying ligament of Marshall (LOM) connections that are responsible for pulmonary vein isolation (PVI) failure, assess their incidence, and determine if they can be targeted by focal endocardial ablation at the anterior carina of the left superior pulmonary vein (LSPV). BACKGROUND Wide antral ablation of the left pulmonary veins (PVs) may not achieve PVI, sometimes requiring empirical ablation of the PV carina. The mechanism could be due to epicardial conduction along the LOM, which courses adjacent to the anterior carina. METHODS In patients undergoing radiofrequency ablation for atrial fibrillation, if wide ablation of the left PV did not achieve isolation, bidirectional mapping was performed. A presumptive LOM connection was diagnosed if the earliest entrance was mapped to the anterior LSPV, while the earliest exit was mapped inferior to the left inferior PV. Focal ablation at the LSPV anterior carina was performed, even if not at the site of earliest entrance activation. The primary endpoint was successful PVI immediately after ablation. RESULTS The study included 455 consecutive patients who underwent 570 procedures, of which 364 were first-time ablations. Presumptive LOM connections were identified in 48 procedures (8.4%) and in 41 patients (11.2%) undergoing first-time ablation and were successfully ablated at the anterior carina of the LSPV in 47 of 48 procedures (98%). CONCLUSIONS LOM connections may be a common cause of PVI failure and can be easily identified and reliably ablated with focal endocardial ablation at the anterior LSPV carina.
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Philibert S, Amet D, De Chirac M, Laurent G. A case report of ethanol infusion in the vein of Marshall using the right jugular vein approach. Eur Heart J Case Rep 2020; 4:1-6. [PMID: 33204957 PMCID: PMC7649458 DOI: 10.1093/ehjcr/ytaa260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/15/2020] [Accepted: 07/13/2020] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Ethanol infusion has recently been described as a curative strategy for certain peri-mitral flutters by blocking electrical conduction across the mitral isthmus along with the Marshall bundle. The present case showed that a right jugular vein approach, less described, may be a good choice when performing an ethanol infusion in the vein of Marshall (VOM).
Case summary
A 45-year-old man was admitted to our unit for dyspnoea associated with an atypical atrial flutter with a cycle length of 320 ms. The left atrial activation map showed a peri-mitral counter-clockwise circuit. The atrial flutter cycle length went up to 345 ms once an endocardial and epicardial point-by point-ablation of the mitral line was completed. At this stage, a new activation map showed that the mitral line was still permeable with an epicardial conduction bridge through the VOM. We decided to use an ethanol infusion for the ablation of the VOM. The coronary sinus could not be thoroughly catheterized due to a winding and angular shape so we decided to try a right jugular vein approach. A total of 9 mL of ethanol was injected into the VOM. A final venogram showed the diffusion of ethanol around the VOM. Sinus rhythm was restored during the last ethanol infusion. A new voltage map confirmed the completion of the mitral line, and we confirmed the bidirectional block.
Discussion
The present case showed that a right jugular vein approach may be a good choice when catheterizing and performing an ethanol infusion in the VOM.
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Affiliation(s)
| | - Denis Amet
- HEGP, 20 rue Leblanc, 75015, Paris, France
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31
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Ganglionated Plexi Ablation for the Treatment of Atrial Fibrillation. J Clin Med 2020; 9:jcm9103081. [PMID: 32987820 PMCID: PMC7598705 DOI: 10.3390/jcm9103081] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/15/2020] [Accepted: 09/23/2020] [Indexed: 01/11/2023] Open
Abstract
Atrial fibrillation (AF) is the most common type of cardiac arrhythmia and is associated with significant morbidity and mortality. The autonomic nervous system (ANS) plays an important role in the initiation and development of AF, causing alterations in atrial structure and electrophysiological defects. The intrinsic ANS of the heart consists of multiple ganglionated plexi (GP), commonly nestled in epicardial fat pads. These GPs contain both parasympathetic and sympathetic afferent and efferent neuronal circuits that control the electrophysiological properties of the myocardium. Pulmonary vein isolation and other cardiac catheter ablation targets including GP ablation can disrupt the fibers connecting GPs or directly damage the GPs, mediating the benefits of the ablation procedure. Ablation of GPs has been evaluated over the past decade as an adjunctive procedure for the treatment of patients suffering from AF. The success rate of GP ablation is strongly associated with specific ablation sites, surgical techniques, localization techniques, method of access and the incorporation of additional interventions. In this review, we present the current data on the clinical utility of GP ablation and its significance in AF elimination and the restoration of normal sinus rhythm in humans.
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32
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He B, Wang X, Zhao F, Guo T, Po SS, Lu Z. The ligament of Marshall and arrhythmias: A review. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 44:792-799. [PMID: 32914878 DOI: 10.1111/pace.14071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/17/2020] [Accepted: 09/09/2020] [Indexed: 01/27/2023]
Abstract
The ligament of Marshall (LOM) is a remnant of the embryonic sinus venosus and left cardinal vein, and contains fat and fibrous tissues, blood vessels, muscle bundles, nerve fibers, and ganglia. The complexity of LOM's structure makes it as a source of triggers and drivers as well as substrates of re-entry for atrial arrhythmias, especially for atrial fibrillation (AF). LOM also serves as a portion of left atrial macro-re-entrant circuit, especially peri-mitral isthmus re-entrant circuit. Experimental studies demonstrate that the LOM acts as a sympathetic conduit between the left stellate ganglion and the ventricles, and participates in the initiation and maintenance of ventricular arrhythmias. Endocardial or epicardial catheter ablation or ethanol infusion into the vein of Marshall may serve as an important adjunct therapy to pulmonary vein isolation in patients with advanced stage of AF, and may help alleviate ventricular arrhythmias as well.
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Affiliation(s)
- Bo He
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiaoying Wang
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Fang Zhao
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Tao Guo
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Sunny S Po
- Heart Rhythm Institute and Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Zhibing Lu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
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Cherian T, Callans DJ. Not so typical: The role of epicardial connections in typical flutter refractory to block across the cavotricuspid isthmus. J Cardiovasc Electrophysiol 2020; 31:2352-2354. [PMID: 32562452 DOI: 10.1111/jce.14626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Tharian Cherian
- Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David J Callans
- Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Briceño DF, Patel K, Romero J, Alviz I, Tarantino N, Della Rocca DG, Natale V, Zhang XD, Di Biase L. Beyond Pulmonary Vein Isolation in Nonparoxysmal Atrial Fibrillation: Posterior Wall, Vein of Marshall, Coronary Sinus, Superior Vena Cava, and Left Atrial Appendage. Card Electrophysiol Clin 2020; 12:219-231. [PMID: 32451106 DOI: 10.1016/j.ccep.2020.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The optimal ablation strategy for non-paroxysmal atrial fibrillation remains controversial. Non-PV triggers have been shown to have a major arrhythmogenic role in these patients. Common sources of non-PV triggers are: posterior wall, left atrial appendage, superior vena cava, coronary sinus, vein of Marshall, interatrial septum, crista terminalis/Eustachian ridge, and mitral and tricuspid valve annuli. These sites are targeted empirically in selected cases or if significant ectopy is noted (with or without a drug challenge), to improve outcomes in patients with non-paroxysmal atrial fibrillation. This article focuses on summarizing the current evidence and the approach to mapping and ablation of these frequent non-PV trigger sites.
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Affiliation(s)
- David F Briceño
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Kavisha Patel
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Jorge Romero
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Isabella Alviz
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Nicola Tarantino
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | | | - Veronica Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Xiao-Dong Zhang
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA.
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Kistler PM, Chieng D. Persistent atrial fibrillation in the setting of pulmonary vein isolation-Where to next? J Cardiovasc Electrophysiol 2019; 31:1857-1860. [PMID: 31778259 DOI: 10.1111/jce.14298] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 11/07/2019] [Indexed: 01/07/2023]
Abstract
Catheter ablation for atrial fibrillation (AF) is indicated in symptomatic patients who are intolerant or refractory to antiarrhythmic therapy. However, outcomes from catheter ablation remain suboptimal in patients with persistent AF. Pulmonary vein antral isolation (PVAI) is established as the cornerstone of AF ablation strategies. The landmark STAR AF II study demonstrated a lack of incremental benefit with adjunctive linear and complex fractionated electrogram ablation beyond PVAI. Randomized studies thus far have failed to consistently show favorable outcomes from other trigger/substrate-based ablation approaches over PVAI alone. In this issue of the journal, we pose an interesting clinical scenario-of a middle-aged female who presents with recurrent persistent AF but was found to have enduring PVAI on repeat electrophysiologic study. Which approach should be undertaken next? In this review article, we aim to provide an overview of ablation strategies beyond PVAI. Finally in light of scant randomized data to guide decision making we have approached leading experts in the field to provide their approach to this scenario.
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Affiliation(s)
- Peter M Kistler
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - David Chieng
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
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Kitamura T, Vlachos K, Denis A, Andre C, Martin R, Pambrun T, Duchateau J, Frontera A, Takigawa M, Thompson N, Cheniti G, Martin CA, Lam A, Bourier F, Sacher F, Hocini M, Haissaguerre M, Jais P, Derval N. Ethanol infusion for Marshall bundle epicardial connections in Marshall bundle-related atrial tachycardias following atrial fibrillation ablation: The accessibility and success rate of ethanol infusion by using a femoral approach. J Cardiovasc Electrophysiol 2019; 30:1443-1451. [PMID: 31187516 DOI: 10.1111/jce.14019] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/03/2019] [Accepted: 06/03/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ethanol infusion of the vein of Marshall (VOM) may be effective to treat Marshall bundle-related atrial tachycardia (MB-AT). However, methods and clinical results of ethanol infusion for MB-AT have been not established. OBJECTIVE To assess the accessibility of the VOM and the success rate of ethanol infusion using a femoral approach for MB-AT. METHODS A single-center observational study included consecutive patients who had MB-AT and in whom we attempted to treat MB-AT during AT by ethanol infusion. When the VOM was able to be cannulated following VOM venogram using a femoral approach, we systematically performed ethanol infusion with selective balloon occlusion of the VOM. We analyzed in detail the efficacy of ethanol infusion of VOM in patients who were in MB-AT during ethanol infusion. RESULTS We enrolled 54 consecutive patients in whom we attempted to treat MB-AT by ethanol infusion. Of those, the VOM was accessible in 92.5% of patients (50 of 54). Of the 50 patients treated by ethanol infusion during MB-AT, AT was successfully terminated in 56% percent of the patients (28 of 50) by solo treatment of ethanol infusion without RF ablation. The remainder required additional RF application to terminate the MB-AT. A mean of 6.2 ± 2.8 mL of ethanol was infused resulting in the low-voltage area significantly larger than that before ethanol infusion (12.7 ± 8.3 vs 6.6 ± 5.3 cm2 , P < .001). CONCLUSION The present study demonstrated that the VOM was highly accessible and MB-AT was amenable to treatment by ethanol infusion by using a femoral approach.
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Affiliation(s)
- Takeshi Kitamura
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
| | | | - Arnaud Denis
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
| | - Clementine Andre
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
| | - Ruairidh Martin
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
| | | | - Antonio Frontera
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
| | | | | | - Ghassen Cheniti
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
| | - Claire A Martin
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
| | - Anna Lam
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
| | - Felix Bourier
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
| | - Frederic Sacher
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
| | - Meleze Hocini
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
| | | | - Pierre Jais
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
| | - Nicolas Derval
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
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Di Biase L, Romero J, Briceno D, Valderrabano M, Sanchez JE, Della Rocca DG, Mohanty P, Horton R, Gallinghouse GJ, Mohanty S, Trivedi C, Beheiry S, Gianni C, Elayi CS, Burkhardt JD, Natale A. Evidence of relevant electrical connection between the left atrial appendage and the great cardiac vein during catheter ablation of atrial fibrillation. Heart Rhythm 2019; 16:1039-1046. [DOI: 10.1016/j.hrthm.2019.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Indexed: 11/28/2022]
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Żabówka A, Hołda J, Strona M, Koziej M, Krawczyk‐Ożóg A, Jasińska KA, Kuniewicz M, Lelakowski J, Hołda MK. Morphology of the Vieussens valve and its imaging in cardiac multislice computed tomography. J Cardiovasc Electrophysiol 2019; 30:1325-1329. [DOI: 10.1111/jce.14018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 05/17/2019] [Accepted: 05/30/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Anna Żabówka
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Jakub Hołda
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Marcin Strona
- Department of Forensic MedicineJagiellonian University Medical College Cracow Poland
| | - Mateusz Koziej
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Agata Krawczyk‐Ożóg
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Katarzyna A. Jasińska
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
| | - Marcin Kuniewicz
- Department of Electrocardiology, Institute of Cardiology, The John Paul II Hospital in CracowJagiellonian University Medical College Cracow Poland
| | - Jacek Lelakowski
- Department of Electrocardiology, Institute of Cardiology, The John Paul II Hospital in CracowJagiellonian University Medical College Cracow Poland
| | - Mateusz K. Hołda
- HEART—Heart Embryology and Anatomy Research Team, Department of AnatomyJagiellonian University Medical College Cracow Poland
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The autonomic nervous system and cardiac arrhythmias: current concepts and emerging therapies. Nat Rev Cardiol 2019; 16:707-726. [DOI: 10.1038/s41569-019-0221-2] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2019] [Indexed: 12/19/2022]
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40
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Valderrábano M. Improving ablation results in persistent AF: Is ethanol the answer? J Cardiovasc Electrophysiol 2019; 30:1229-1230. [PMID: 31148309 DOI: 10.1111/jce.13971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/01/2019] [Indexed: 01/23/2023]
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41
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Garcia F, Enriquez A, Arroyo A, Supple G, Marchlinski F, Saenz L. Roof-dependent atrial flutter with an epicardial component: Role of the septopulmonary bundle. J Cardiovasc Electrophysiol 2019; 30:1159-1163. [DOI: 10.1111/jce.13885] [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: 01/14/2019] [Revised: 02/08/2019] [Accepted: 02/16/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Fermin Garcia
- Section of Cardiac Electrophysiology, Department of Medicine; Hospital of the University of Pennsylvania; Philadelphia PA
| | - Andres Enriquez
- Division of Cardiology; Queen's University; Kingston Ontario Canada
| | - Alonso Arroyo
- International Arrhythmia Center, CardioInfantil Foundation; Bogotá Colombia
| | - Gregory Supple
- Section of Cardiac Electrophysiology, Department of Medicine; Hospital of the University of Pennsylvania; Philadelphia PA
| | - Francis Marchlinski
- Section of Cardiac Electrophysiology, Department of Medicine; Hospital of the University of Pennsylvania; Philadelphia PA
| | - Luis Saenz
- International Arrhythmia Center, CardioInfantil Foundation; Bogotá Colombia
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Tavares L, Valderrábano M. Retrograde venous ethanol ablation for ventricular tachycardia. Heart Rhythm 2019; 16:478-483. [DOI: 10.1016/j.hrthm.2018.09.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Indexed: 10/28/2022]
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Yu X, He W, Qin Z, Liu S, Ma R, Luo D, Hu H, Xie J, He B, Lu Z, Jiang H. Selective ablation of the ligament of Marshall attenuates atrial electrical remodeling in a short-term rapid atrial pacing canine model. J Cardiovasc Electrophysiol 2018; 29:1299-1307. [PMID: 29864240 DOI: 10.1111/jce.13658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 05/27/2018] [Accepted: 05/30/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cardiac sympathetic activation facilitates atrial electrical remodeling during atrial fibrillation (AF). Selective ablation of the distal part of the ligament of Marshall (LOMLSPV ) could decrease cardiac sympathetic innervation. This study aimed to investigate the effects of LOMLSPV ablation on atrial electrical remodeling in a short-term rapid atrial pacing (RAP) model. METHODS In 16 anesthetized dogs, 6 hours of RAP (20 Hz, 2 × threshold) was delivered before LOMLSPV ablation (group 1, N = 8) or after (group 2, N = 8). Heart rate variability (HRV), serum norepinephrine (NE), atrial electrophysiological indices were analyzed. Six times of burst pacing (20 Hz, 2 × threshold, lasting for 5 seconds, were performed to induce AF, the number of episodes and the duration of AF were compared. RESULTS LOMLSPV ablation decreased sympathetic indices of HRV and serum NE. Atrial effective refractory period (ERP) was shortened during RAP in both groups with higher reduction degrees in group 1. In group 1, the shortening of atrial ERP, elevating of ERP dispersion and sum of window of vulnerability (ΣWOV), facilitating of AF induced by RAP were subsequently reversed by LOMLSPV ablation. In group 2, LOMLSPV ablation prolonged atrial ERP, decreased ΣWOV, eliminated AF induction. The subsequent RAP failed to alter these indices. Histological studies showed abundant sympathetic nerve fibers in LOMLSPV . CONCLUSION LOMLSPV ablation could inhibit atrial electrical remodeling during short-term RAP by reducing the cardiac sympathetic activity. LOMLSPV may be a potential target in AF ablation, especially in patients with highly cardiac sympathetic activation or atrial electrical remodeling.
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Affiliation(s)
- Xiaomei Yu
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Wenbo He
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Zhiliang Qin
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Shan Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Ruisong Ma
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Da Luo
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Huihui Hu
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Jing Xie
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Bo He
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Zhibing Lu
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan, China.,Department of Cardiology, Huangshi Central Hospital, Hubei Polytechnic University, Huangshi, China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, Wuhan, China
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Baskar S, Attari M, Czosek RJ, Jais P, Anderson JB, Spar DS. An unusual cause of lone atrial fibrillation in a young female subject due to a rapid-cycling focal atrial trigger. HeartRhythm Case Rep 2018; 4:204-208. [PMID: 29922577 PMCID: PMC6006482 DOI: 10.1016/j.hrcr.2018.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Shankar Baskar
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | - Pierre Jais
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | | | - David S. Spar
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Address reprint requests and correspondence: Dr David S. Spar, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229.
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Liu S, Yu X, Luo D, Qin Z, Wang X, He W, Ma R, Hu H, Xie J, He B, Lu Z, Jiang H. Ablation of the Ligament of Marshall and Left Stellate Ganglion Similarly Reduces Ventricular Arrhythmias During Acute Myocardial Infarction. Circ Arrhythm Electrophysiol 2018; 11:e005945. [PMID: 29700056 DOI: 10.1161/circep.117.005945] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 03/12/2018] [Indexed: 01/09/2023]
Abstract
Background:
Sympathetic denervation exerts protective effects against ventricular arrhythmias (VAs) induced by acute myocardial infarction. The results of a previous study indicated that the distal part of the ligament of Marshall (LOM
LSPV
) might be a sympathetic conduit between the left stellate ganglion (LSG) and the ventricles. The present study was designed to compare the effects between LSG and LOM
LSPV
ablation on ischemia-induced VAs.
Methods:
Twenty-nine dogs were randomly divided into sham ablation group (group 1, n=9), LOM
LSPV
ablation group (group 2, n=10), and LSG ablation group (group 3, n=10). Ablation was performed before occlusion of the left anterior coronary artery. Changes in the heart rate variability, serum norepinephrine, ventricular effective refractory period, and blood pressure induced by LSG stimulation were observed, and the occurrence of VAs was recorded. Immunostaining examinations of LOM
LSPV
were performed in dogs without ablation.
RESULTS:
In group 2, LOM
LSPV
ablation evidently attenuated blood pressure elevation induced by LSG stimulation. Both LOM
LSPV
ablation and LSG ablation similarly prolonged ventricular effective refractory period and reduced the concentration of serum norepinephrine, the sympathetic index of heart rate variability, and the incidence of VAs compared with sham ablation. Abundant sympathetic nerve fibers were observed in LOM
LSPV
.
Conclusions:
LOM
LSPV
ablation prevented acute myocardial infarction–induced VAs with the same efficiency as LSG ablation, potentially by blocking the sympathetic pathway from the LSG to the heart.
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Affiliation(s)
- Shan Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Cardiovascular Research Institute, Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
| | - Xiaomei Yu
- Department of Cardiology, Renmin Hospital of Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Cardiovascular Research Institute, Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
| | - Da Luo
- Department of Cardiology, Renmin Hospital of Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Cardiovascular Research Institute, Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
| | - Zhiliang Qin
- Department of Cardiology, Renmin Hospital of Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Cardiovascular Research Institute, Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
| | - Xiaoying Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Cardiovascular Research Institute, Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
| | - Wenbo He
- Department of Cardiology, Renmin Hospital of Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Cardiovascular Research Institute, Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
| | - Ruisong Ma
- Department of Cardiology, Renmin Hospital of Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Cardiovascular Research Institute, Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
| | - Huihui Hu
- Department of Cardiology, Renmin Hospital of Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Cardiovascular Research Institute, Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
| | - Jing Xie
- Department of Cardiology, Renmin Hospital of Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Cardiovascular Research Institute, Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
| | - Bo He
- Department of Cardiology, Renmin Hospital of Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Cardiovascular Research Institute, Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
| | - Zhibing Lu
- Department of Cardiology, Renmin Hospital of Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Cardiovascular Research Institute, Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Department of Cardiology, Huangshi Central Hospital, Hubei Polytechnic University, China (Z.L.)
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Cardiovascular Research Institute, Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
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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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48
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Isolation of the conduction between the Marshall bundle and distal coronary sinus and the entire coronary sinus for an atrial tachycardia after catheter ablation of atrial fibrillation. HeartRhythm Case Rep 2017; 3:360-363. [PMID: 28748145 PMCID: PMC5511981 DOI: 10.1016/j.hrcr.2017.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kashimura S, Nishiyama T, Kimura T, Nishiyama N, Aizawa Y, Takatsuki S. Vein of Marshall partially isolated with radiofrequency ablation from the endocardium. HeartRhythm Case Rep 2017; 3:120-123. [PMID: 28491784 PMCID: PMC5420049 DOI: 10.1016/j.hrcr.2016.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Shin Kashimura
- Department of Cardiology, Keio University Hospital, Tokyo, Japan
| | | | - Takehiro Kimura
- Department of Cardiology, Keio University Hospital, Tokyo, Japan
| | | | - Yoshiyasu Aizawa
- Department of Cardiology, Keio University Hospital, Tokyo, Japan
| | - Seiji Takatsuki
- Department of Cardiology, Keio University Hospital, Tokyo, Japan
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50
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Valderrábano M, Morales PF, Rodríguez-Mañero M, Lloves C, Schurmann PA, Dave AS. The Human Left Atrial Venous Circulation as a Vascular Route for Atrial Pharmacological Therapies: Effects of Ethanol Infusion. JACC Clin Electrophysiol 2017; 3:1020-1032. [PMID: 29759706 DOI: 10.1016/j.jacep.2017.02.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 01/31/2017] [Accepted: 02/09/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study catalogued the human venous left atrium (LA) circulation system and the ablative effects of ethanol in different branches. BACKGROUND Vascular routes to target the LA could have significant therapeutic potential. Beyond the vein of Marshall (VOM), the fluoroscopic LA venous anatomy has not been described. METHODS Patients undergoing ethanol infusion in the VOM as adjunctive therapy to atrial fibrillation (AF) catheter ablation were included in this study. Balloon occlusion venograms of the VOM and other LA veins were obtained in 218 patients. RESULTS Sequentially from the coronary sinus (CS) ostium, LA veins included: 1) proximal septal vein draining the inferior septum; 2) inferior LA vein in the annular inferior LA; 3) VOM; 4) LA appendage vein; and 4) anterior LA vein. Additionally, venous sinuses not connected to the CS included roof veins and posterior wall veins, which drained into the right and left atria, respectively. Venous connections between LA veins through capillaries and with pulmonary veins were abundant. Extracardiac collateral vessels were present in 38 patients (17.4%). Ethanol infusion in LA veins led to tissue ablation in their corresponding regions. CONCLUSIONS The atrial venous anatomy is amenable to selective cannulation. Consistent anatomical patterns are present. Targeting atrial tissues through atrial veins can be used for therapeutic purposes.
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Affiliation(s)
- Miguel Valderrábano
- Division of Cardiac Electrophysiology, Methodist DeBakey Heart and Vascular Center and Houston Methodist Hospital, Houston, Texas.
| | - Percy Francisco Morales
- Division of Cardiac Electrophysiology, Methodist DeBakey Heart and Vascular Center and Houston Methodist Hospital, Houston, Texas
| | - Moisés Rodríguez-Mañero
- Division of Cardiac Electrophysiology, Methodist DeBakey Heart and Vascular Center and Houston Methodist Hospital, Houston, Texas
| | - Candela Lloves
- Division of Cardiac Electrophysiology, Methodist DeBakey Heart and Vascular Center and Houston Methodist Hospital, Houston, Texas
| | - Paul A Schurmann
- Division of Cardiac Electrophysiology, Methodist DeBakey Heart and Vascular Center and Houston Methodist Hospital, Houston, Texas
| | - Amish S Dave
- Division of Cardiac Electrophysiology, Methodist DeBakey Heart and Vascular Center and Houston Methodist Hospital, Houston, Texas
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