Radiofrequency Catheter Ablation Targeting the Vein of Marshall in Difficult Mitral Isthmus Ablation or Pulmonary Vein Isolation

Abstract

Selective VOM venography using an irrigated ablation catheter is feasible and safe. RF ablation targeting the VOM may provide additional benefit in failed cases of MI block or PVI.

Ablating the Obscure: The Curious Case of the Vein of Marshall

“…11 The study population was culled from a retrospective analysis of 367 consecutive patients who underwent ablation for AF and/or atypical atrial flutter. 11 The study population was culled from a retrospective analysis of 367 consecutive patients who underwent ablation for AF and/or atypical atrial flutter.…”

“…11 CS venography, performed in 37 of 66 patients with persistent conduction, identified the VOM in 19 ( 50%) patients. 11 CS venography, performed in 37 of 66 patients with persistent conduction, identified the VOM in 19 ( 50%) patients.…”

“…11 Bidirectional block can sometimes be difficult to achieve during ablation of the lateral mitral isthmus for the treatment of perimitral flutter. The use of an open irrigation ablation catheter for nonocclusive venography of the CS and selective venography of the VOM is technically accessible and quick to perform.…”

“…The use of an open irrigation ablation catheter for nonocclusive venography of the CS and selective venography of the VOM is technically accessible and quick to perform. 11 The particular advantage of the technique of Lee et al 11 is that other laboratories should be able to readily replicate their method with only a marginal change in workflow, incremental procedure duration, or increased fluoroscopic exposure. 11 Bidirectional block can sometimes be difficult to achieve during ablation of the lateral mitral isthmus for the treatment of perimitral flutter.…”

“…The authors report that the VOM is visualized in approximately 50% of patients by their method and that success occurs in two-thirds of patients who previously failed ablation endpoints. However, these advantages are mitigated by the lower rate of VOM identification with an open-irrigated method (50%) 11 versus an occlusive venography method (75%), 4 as well as by a lower overall success rate in achieving bidirectional block. One factor may be due to the persistence of muscle sleeves surrounding the CS.…”