Ethanol infusion for Marshall bundle epicardial connections in Marshall bundle-related atrial tachycardias following atrial fibrillation ablation: The accessibility and success rate of ethanol infusion by using a femoral approach.

BACKGROUND

Ethanol infusion of the vein of Marshall (VOM) may be effective to treat Marshall bundle-related atrial tachycardia (MB-AT). However, methods and clinical results of ethanol infusion for MB-AT have been not established.

OBJECTIVE

To assess the accessibility of the VOM and the success rate of ethanol infusion using a femoral approach for MB-AT.

METHODS

A single-center observational study included consecutive patients who had MB-AT and in whom we attempted to treat MB-AT during AT by ethanol infusion. When the VOM was able to be cannulated following VOM venogram using a femoral approach, we systematically performed ethanol infusion with selective balloon occlusion of the VOM. We analyzed in detail the efficacy of ethanol infusion of VOM in patients who were in MB-AT during ethanol infusion.

RESULTS

We enrolled 54 consecutive patients in whom we attempted to treat MB-AT by ethanol infusion. Of those, the VOM was accessible in 92.5% of patients (50 of 54). Of the 50 patients treated by ethanol infusion during MB-AT, AT was successfully terminated in 56% percent of the patients (28 of 50) by solo treatment of ethanol infusion without RF ablation. The remainder required additional RF application to terminate the MB-AT. A mean of 6.2 ± 2.8 mL of ethanol was infused resulting in the low-voltage area significantly larger than that before ethanol infusion (12.7 ± 8.3 vs 6.6 ± 5.3 cm , P < .001).

CONCLUSION

The present study demonstrated that the VOM was highly accessible and MB-AT was amenable to treatment by ethanol infusion by using a femoral approach.