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. 2020 Jan;43(1):47-53.
doi: 10.1111/pace.13839. Epub 2019 Nov 25.

Chemical mapping as a predictor of vein of Marshall ethanol ablative effects

Kaoru Okishige  1 , Takatoshi Shigeta  1 , Takuro Nishimura  1 , Rena A Nakamura  1 , Tatsuhiko Hirao  1 , Hiroshi Yoshida  1 , Yasuteru Yamauchi  1 , Takehiko Keida  2 , Tetsuo Sasano  3 , Kenzo Hirao  3 , Miguel Valderrábano  4   5
Affiliations

Chemical mapping as a predictor of vein of Marshall ethanol ablative effects

Kaoru Okishige et al. Pacing Clin Electrophysiol. 2020 Jan.

Abstract

Purpose: The aim of this study was to test regional pharmacological effects of an antiarrhythmic agents to predict ablative effects.

Background: The vein of Marshall (VOM) providing vascular access to myocardial tissue has been used for ablative purposes using ethanol.

Methods: A total of 35 patients (male 21, 63.2 ± 7.8 years old) were included. A balloon-tipped infusion catheter was inserted into the VOM. Endocardial ultrahigh-resolution mapping was performed along the VOM region to record the change in atrial electrograms (AEs) after VOM injection of cibenzoline of 3.5 mg during sustained atrial fibrillation (AF). Subsequently, ethanol was infused into the VOM and ablative region was mapped.

Results: In 17 patients (49 %), cibenzoline reduced AEs amplitude by >50%, all of which had also complete elimination of AEs following ethanol (Group A). In 18 patients (Group B), cibenzoline failed to eliminate AEs; yet, in 13 of 18 AEs were eliminated by ethanol. In the remaining five patients, ethanol did not eliminate AE.

Conclusions: Cibenzoline into the VOM could reliably predicts the results of subsequent ethanol infusion into the VOM using ultrahigh-resolution mapping system, which leads to avoid unnecessary permanent lesion creation by ethanol infusion.

Keywords: Marshall vein; atrial fibrillation; chemical ablation; cibenzoline.

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References

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