Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Ablation Techniques D-PO02 - Poster Session II (ID 47) Poster

D-PO02-140 - Ethanolisation Of The Marshall Vein In Persistent Af Ablation (ID 222)

 A. Almorad: Nothing relevant to disclose.


Background: Although pulmonary vein isolation (PVI) is effective in the treatment of paroxysmal atrial fibrillation, its success rates in persistent AF are suboptimal. Prior studies suggested that vein of Marshall (VOM) ethanolisation might increase ablation success.
Objective: To evaluate the safety and feasibility of VOM ethanolisation (VOM-E) and its impact on left atrial electrogram amplitude and the easy of creating bi-directional block at the mitral isthmus (MI).
Methods: In 34 consecutive patients referred for either first or redo ablation of persistent AF, ethanolisation of the VOM was performed. After catheterization of the VOM, 3mL of ethanol (98%) was injected 3 times. A high definition voltage map to identify low-voltage areas (LVA, <0.5mV) was performed before and after VOM-E. If no block was observed at the MI, endocardial followed by epicardial RF was applied. Procedural parameters were collected.
Results: VOM-E was successfully performed in 33 out of 34 patients (97%). In all cases, VOM-E resulted in a new LVA of 6.5±4.0 cm2. Compared to patients with a limited LVA (<10.0 cm², n=26), patients with a large LVA (n=7) required less RF applications to achieve MI block (6.7±3.1 vs 24.5±10.1, p<0.5), 3 of them without epicardial RF (3 vs 0, p<0.5). Three patients developed pericarditis (8,8%). No major complication was observed.
Conclusion: VOM ethanol infusion is feasible in the vast majority of patients with an acceptable safety profile. The impact on atrial electrogram voltage is heterogenous. In patients with large area of low-voltage after VOM-E, catheter ablation and block of the mitral isthmus seem to be facilitated.