Alcohol Ablation of Vein of Marshall for Persistent Atrial Fibrillation

Alcohol Ablation of Vein of Marshall for Persistent Atrial Fibrillation Highly diagrammatic representation of coronary veins Vein of Marshall (VOM) is a tributary of the coronary sinus with abundant sympathetic and parasympathetic innervation. It has been implicated in the genesis and maintenance of atrial fibrillation (AF).  Three reasons described are the myocardial extensions into the structure, node like remnants within the vein and the rich autonomic innervation surrounding it [1] It is anatomically related to the mitral isthmus. Mitral isthmus is the region between the left inferior pulmonary vein ostium and the mitral annulus. Oblique vein of Marshall is the residua of the embryonic left superior cardinal vein [2]. Though pulmonary vein isolation (PVI) is effective in the treatment of paroxysmal atrial fibrillation, the role in persistent atrial fibrillation is suboptimal [3]. A common form of ablation failure is recurrence as peri-mitral flutter. VOM is in the re-entrant circuit of peri-mitral flutter and VOM ablation can abolish peri-mitral flutter. Effect on sympathetic and parasympathetic innervation is another important aspect of VOM ablation. VENUS (Vein of Marshall Ethanol for Untreated Persistent AF) trial enrolled patients undergoing their first catheter ablation for AF, while MARS-AF enrolled patients undergoing ablation after previous ablation failure. Both were National Heart, Lung, and Blood Institute (NHLBI) funded randomized controlled trials. The trial...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: ECG / Electrophysiology Source Type: blogs