Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research Institute, The Methodist Hospital, Houston, Texas 77030, USA.
Heart Rhythm. 2009 Nov;6(11):1552-8. doi: 10.1016/j.hrthm.2009.07.036. Epub 2009 Jul 21.
The vein of Marshall (VOM) is a left atrial (LA) vein that contains autonomic innervation and triggers of AF. Its location coincides with areas usually ablated during pulmonary vein (PV) antral isolation (PVAI).
This study sought to delineate the safety and ablative effects of ethanol infusion in the VOM during catheter ablation of atrial fibrillation (AF).
Patients undergoing PVAI (n = 14) gave consent for adjunctive VOM ethanol infusion. In 10 of 14 patients, the VOM was cannulated with an angioplasty wire and balloon. Echocardiographic contrast was injected in the VOM under echocardiographic monitoring. Two infusions of 100% ethanol (1 ml each) were delivered via the angioplasty balloon in the VOM. LA bipolar voltage maps were created before and after ethanol infusion. Radiofrequency ablation times required to isolate each PV and other procedural data were compared with those of 10 age-, sex-, AF type- and LA size-matched control subjects undergoing conventional PVAI.
The VOM communicated with underlying myocardium, as shown by echocardiographic contrast passage into the LA. There were no acute complications related to VOM ethanol infusion, which led to the creation of a low-voltage area in the LA measuring 10.6 +/- 7.6 cm(2) and isolation of the left inferior PV in 4 of 10 patients. Radiofrequency ablation time required to achieve isolation of the left inferior PV was reduced (2.2 +/- 4 min vs. 11.4 +/- 10.3 min in control subjects, P <.05).
VOM ethanol infusion is safe in humans, decreases radiofrequency ablation time in the left inferior PV, and may have a role as an adjunct to PVAI.
Marshall 静脉（VOM）是一条左心房（LA）静脉，其中包含自主神经支配和触发 AF 的触发点。其位置与肺静脉（PV）窦隔离（PVAI）期间通常消融的区域重合。
本研究旨在描述在导管消融心房颤动（AF）期间，Marshall 静脉（VOM）内乙醇输注的安全性和消融效果。
接受 PVAI（n = 14）的患者同意进行辅助 VOM 乙醇输注。在 14 例患者中的 10 例中，用血管成形术导丝和球囊对 VOM 进行了插管。在超声心动图监测下，将超声心动图对比剂注入 VOM。通过 VOM 中的血管成形术球囊，每次输注 100%乙醇 1 毫升，共 2 次。在乙醇输注前后创建 LA 双极电压图。比较 VOM 乙醇输注的 LA 双极电压图前后创建的射频消融时间与 10 例年龄、性别、AF 类型和 LA 大小匹配的接受常规 PVAI 的对照患者的射频消融时间。
VOM 与下方的心肌相通，超声心动图对比剂进入 LA 证明了这一点。VOM 乙醇输注无急性并发症，导致 LA 中形成一个低电压区域，面积为 10.6 +/- 7.6 cm(2)，在 10 例患者中的 4 例中隔离了左下 PV。实现左下 PV 隔离所需的射频消融时间缩短（2.2 +/- 4 分钟 vs. 对照组中的 11.4 +/- 10.3 分钟，P <.05）。
VOM 乙醇输注在人体中是安全的，可减少左下 PV 的射频消融时间，并可能作为 PVAI 的辅助手段。
