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.Mitral isthmus ablation: A hierarchical approach guided by electroanatomic correlation
Mitral isthmus ablation is an established technique used to treat perimitral atrial flutter. The classic approach involves creating an ablation line connecting the left inferior pulmonary vein (LIPV) to the lateral mitral annulus.1 Its feasibility was first prospectively studied by Jais et al,1 who reported a high rate of bidirectional block. However, subsequent studies by the same group, as well as others, have been less promising.2 This is important because failure to achieve bidirectional block with ablation has been shown to be proarrhythmic.
