Hands On
How to perform ethanol ablation of the vein of Marshall for treatment of atrial fibrillation
The arrhythmogenicity of the vein of Marshall (VoM) in atrial fibrillation (AF) has been known for more than 20 years.1 A recent randomized trial showed a reduced odds ratio (0.63; 95% confidence interval 0.41–0.97; P = .04) for the primary outcome of AF or atrial tachycardia (AT) recurrence in patients with persistent AF by adding VoM ethanol infusion (VoM-Et) to the standard ablation approach.2 The VoM is involved in 30% of ATs after AF ablation, and VoM ablation significantly improves the freedom from recurrent arrhythmia.How to perform linear lesions
Atrial fibrillation (AF) is a particularly complex arrhythmia because the mechanisms leading to fibrillation are not fully understood. Accordingly, ablation strategies have evolved largely on an empirical basis. The creation of linear lesions is a fundamental strategy that is indispensable to an electrophysiology laboratory performing ablation for treatment of this arrhythmia.
