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Case Reports
. 2024 Jul 26;10(11):780-783.
doi: 10.1016/j.hrcr.2024.07.019. eCollection 2024 Nov.

Ethanol infusion in the vein of Marshall in atrial fibrillation with dextrocardia

Qi Guo  1 , Wenli Dai  1 , Jing Cui  1 , Xueyuan Guo  1 , Caihua Sang  1 , Changsheng Ma  1
Affiliations
Case Reports

Ethanol infusion in the vein of Marshall in atrial fibrillation with dextrocardia

Qi Guo et al. HeartRhythm Case Rep. .
No abstract available

Keywords: Atrial fibrillation; Catheter ablation; Dextrocardia; Ethanol; Vein of Marshall.

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Conflict of interest statement

The authors have no conflicts to disclose.

Figures

Figure 1
Figure 1
Intracardiac electrograms and the ablation map from the 3-dimensional electroanatomical mapping system. Left panel shows the intracardiac electrogram of the patient; middle and right panels are the maps of ablation including pulmonary vein isolation, mitral isthmus, roofline, and tricuspid isthmus. (Middle panel is the ablation map in posteroanterior position; right panel is the map in right anterior oblique 30° position.) CTI = tricuspid isthmus; LAA = left atrial appendage; LSPV = left superior pulmonary vein; MV = mitral valve; RPV = right pulmonary vein.
Figure 2
Figure 2
Ethanol infusion in the vein of Marshall (VOM) in atrial fibrillation with dextrocardia. A: Angiography under the left anterior oblique view of 30° identified the ostium of the VOM (yellow arrow). B: An over-the-wire balloon was inflated in the VOM. C: Myocardial contrast after the ethanol infusion (white arrow). D: Low-voltage area in the left atrium after the ethanol infusion in the right anterior oblique view.
Figure 3
Figure 3
Differential pacing of the mitral isthmus (MI) before and after vein of Marshall ethanol infusion (VOM-EI). A: The pacing position was at the ridge before VOM-EI in the right anterior oblique 45° view. B: Before the VOM-EI, pacing CS 1-2 showed the time from stim to ABL was 115 ms, which demonstrated the MI was unblocked. C: Voltage map of the left atrium after VOM-EI in the right anterior oblique 30° view. D: The pacing position was at the ridge after VOM-EI in the right anterior oblique 45° view. E: After the VOM-EI, pacing CS 1-2 showed the time from stim to ABL was 168 ms, which demonstrated the MI was blocked clockwise. F: After the VOM-EI, when pacing ABL, the conduction of the coronary sinus is from CS 9-10 to CS 1-2, which demonstrated the MI was blocked counterclockwise. ABL = ablation catheter; CS = coronary sinus; LAA = left atrial appendage; LPV = left pulmonary vein; MV = mitral valve.
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