Research On Key Technologies Of Marshall Intravenous Alcohol Ablation For Atrial Fibrillatio

Part Ⅰ Angiographic Characteristics of the Vein of Marshall in Patients with and without Atrial FibrillationBackground:Ethanol infusion into the vein of Marshall(Et-VOM)is a novel treatment for atrial fibrillation(AF).However,few studies have focused on the difference between AF and non-AF patients(presented other types of arrhythmias)regarding the characteristics of the vein of Marshall(VOM).Objective:This study sought to investigate the incidence,morphology,and angiographic characteristics of the VOM.Methods:This study consecutively enrolled all patients with tachyarrhythmias who underwent radiofrequency catheter ablation(RFCA)in Fuwai Hospital between November 2021 and April 2022.Coronary sinus(CS)angiography was performed in all patients.The baseline,angiographic characteristics,and measurements of VOM dimensions were compared between the AF and non-AF group.Results:CS angiography was successfully performed in 290 patients.The VOM detection rate was significant higher in the AF group than in the non-AF group(91.8%vs.84.1%,P=0.044).In the right anterior oblique(RAO)projection,AF patients had significant larger VOM ostium,CS ostium,and CS diameter at VOM ostium than non-AF patients(1.9±0.9 mm vs.1.7±0.7 mm,P=0.015;12.8 ± 4.1 mm vs.11.4 ± 3.7 mm,P=0.016;9.1 ± 3.1 mm vs.8.21 2.9 mm,P=0.028,respectively).There was a slight linear correlation between the VOM ostium and the CS ostium diameter as well as left atrial volume(LAV).Conclusion:AF patients seem to have a higher incidence of the VOM,larger VOM ostium,CS ostium,and CS lumen in the RAO view.Meanwhile,the VOM ostium may correlate with the CS ostium and LAV.Part Ⅱ Angiographic assessment of vein of Marshall in atrial fibrillation:implications for identification and cannulationBackground:The vein of Marshall(VOM)ethanol infusion improves rhythm control in atrial fibrillation(AF).The identification and cannulation of the VOM can be technically challenging.Objective:This study aimed to assess the angiographic morphology of the VOM and investigate its value in the VOM ethanol infusion.Methods:This study consecutive enrolled all patients with AF(n=162)scheduled for combined catheter ablation and VOM ethanol infusion in Fuwai Hospital between November 2021 and April 2022.The VOM morphologic features in the right anterior oblique(RAO)30°,the left anterior oblique(LAO)30°,and the LAO cranial 30 ° views were analyzed.The impact of morphology on the identification and cannulation of the VOM was investigated.Results:The VOM was identified in 159(98.1%)and cannulated in 150(92.6%)patients.The VOM identification rate in the RAO and LAO/LAO cranial view was 97.3%and 89.3%,respectively.Most patients had a VOM ostium clock-location in the LAO/LAO cranial view(VOMoClock)of ≤ 3 o’clock and 3-4 o’clock.The VOM cannulation success rate in the ≤3 o’clock,3-4 o’clock,4-5 o’clock,and 5-6 o’clock group was 100.0%,92.6%,88.5%,and 77.8%,respectively(P=0.032).The median(interquartile range)cannulation time in the four groups was 10.5(6.3),12.0(9.0),13.0(23.0),and 34.0(30.0)minutes,respectively(P<0.001).The diameter of the coronary sinus ostium in the RAO view and the VOMoClock were independent predictors for difficult cannulation.Conclusion:The VOM morphologic features in different angiographic views provide valuable information which could facilitate the identification and cannulation of the VOM.Part Ⅲ Double-wire technique to facilitate vein of Marshall cannulation and ethanol infusion in atrial fibrillationBackground:The vein of Marshall(VOM)ethanol infusion is increasingly performed in combination with catheter ablation in atrial fibrillation(AF).The cannulation of the VOM can sometimes be challenging.Objective:This study aimed to evaluate the double-wire technique in cases of difficult cannulation of the VOM.Methods:Patients with AF scheduled for combined catheter ablation and VOM ethanol infusion in Fuwai hospital between November 2021 and April 2022 were consecutively enrolled.The procedure was performed via the femoral vein.If the regular cannulation technique with one angioplasty wire failed or took more than 20 minutes,the double-wire technique using a stabilizing wire and a cannulation wire was performed.The unique technique was used mainly in two scenarios,when the Eustachian ridge was too prominent as a barrier for catheter manipulation or when the ostium of the VOM was close to the coronary sinus ostium.Results:Of 162 patients scheduled for VOM ethanol infusion,the double-wire technique was applied in 6(3.7%)patients and led to a 100.0%successful cannulation rate of the VOM.Of the six patients,two had a prominent Eustachian ridge,and four had a VOM ostium close to the coronary sinus ostium.The mean cannulation time was 33.3± 7.3 minutes.The ethanol infusion was successfully performed in 5 patients.One patient had a collateral circulation in the distal VOM,and ethanol infusion was not performed.Conclusions:The double-wire technique can facilitate VOM cannulation and ethanol infusion in challenging cases.