Figure 1. Durability of atrial lesions created by EIVM
A. EIVM in a 53-year-old man referred for EIVM and catheter
ablation of persistent AF. Contrast injection in the VOM through a LIMA
angiographic catheter. B. After balloon expansion at the
proximal VOM, the VOM network is seen with an aspect of LA myography.C. LA bipolar voltage map (PentaRay) during AF before EIVM
shows absence of scar in the VOM region. D. Immediately after
EIVM, repeated bipolar voltage map (still in AF) shows a scar (defined
as bipolar voltage < 0.05 mV) of 6.2 cm2 in
the VOM region calculated by the area measurement tool of the CARTO
system (outlined in green dots). The left PV area was excluded from EIVM
scar area calculation because PV volume acquisition may vary
significantly between procedures. Complementary RF at the mitral annulus
edge of the MI was necessary to obtain the MI block. Additional RF
lesions were created for PV isolation and roof-line block. E.Seven months after the index procedure, the patient was referred for
repeat catheter ablation for recurrent AF. Bipolar voltage mapping
(PentaRay) shows the persistence and durability of the EIVM-created scar
(< 0.05 mV; 6.6 cm2) in the VOM region. Scar
region at the mitral annulus edge of the MI was not integrated in the
area calculation because of complementary RF applications during the
index procedure. Abbreviations: AF: atrial fibrillation; EIVM: ethanol
infusion in the vein of Marshall; LA, left atrial; MI: mitral isthmus;
PV: pulmonary vein; RF: radiofrequency; VOM: vein of Marshall.
Figure 2. Evolution of scar area in the VOM region,
immediately and late after EIVM.
Comparative statistical analyses involved the Wilcoxon matched-pairs
signed rank test.
*** P <0.0001.
Abbreviations. EIVM: ethanol infusion in the vein of Marshall; VOM: vein
of Marshall.