Introduction
The vein of Marshall (VOM), which runs in the epicardial posterolateral
left atrium toward the coronary sinus (CS), is a target structure for AF
ablation. It crosses the epicardial aspect of the mitral isthmus (MI)
and contains cardiac autonomic nervous system structures, hosts atrial
fibrillation (AF) drivers. Ablation of the VOM is required for treating
perimitral left atrial (LA) flutter (PMLAF).1–3 For
these reasons, the VOM represents an interesting target for AF and PMLAF
catheter ablation (CA). Ethanol infusion in the VOM (EIVM) is the
most-used technique because it uses the VOM as a vascular access to
myocardial tissue and provides direct damage to the atrial myocardium
drained by the VOM.2,4,5
Adjunct EIVM has been shown to provide good long-term freedom from
atrial tacchyarrhythmia (AT) after non-paroxysmal AF ablation and
improves acute and mid-term success of PMLAF ablation by addressing
epicardial connections at the MI.6–13 As opposed to
radiofrequency (RF) ablation, which provides direct thermal injury to
tissue, EIVM-created atrial scarring relies on a different
mechanism.2 Acute EIVM-induced atrial scarring in the
VOM region has been demonstrated 5,9,14,15, but little
is known about the long-term EIVM effect and the persistence of acute
EIVM-created lesions.
In this study, we assessed the durability of EIVM by comparing acute and
late scar induced by EIVM in patients who underwent redo LA procedure.