Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital (CHU), University of Bordeaux, Pessac-Bordeaux, France.
Department of Cardiovascular Medicine, Division of Arrhythmia and Electrophysiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
J Cardiovasc Electrophysiol. 2022 Aug;33(8):1687-1693. doi: 10.1111/jce.15573. Epub 2022 Jun 4.
Systematic and quantitative descriptions of vein of Marshall (VOM)-induced tissue ablation are lacking. We sought to characterize the distribution of low voltage observed in the left atrium (LA) after VOM ethanol infusion.
The distribution of ethanol-induced low voltage was evaluated by comparing high-density maps performed before and after VOM ethanol infusion in 114 patients referred for atrial fibrillation ablation. The two most frequently impacted segments were the inferior portion of the ridge (82.5%) and the first half of the mitral isthmus (pulmonary vein side) (92.1%). Low-voltage absence in these typical areas resulted from inadvertent ethanol infusion in the left atrial appendage vein (n = 3), initial VOM dissection (n = 3), or a "no branches" VOM morphology (n = 1). Visible anastomosis of the VOM with roof or posterior veins more frequently resulted in low-voltage extension beyond typical areas, toward the entire left antrum (19.0% vs. 1.9%, p = .0045) or the posterior LA (39.7% vs. 3.8%, p < .001) but with a limited positive predictive value ranging from 29.4% to 43.5%. Ethanol-induced low voltage covered a median LA surface of 3.6% (1.9%-5.0%) and did not exceed 8% of the LA surface in 90% of patients.
VOM ethanol infusion typically locates at the inferior ridge and the adjacent half of the mitral isthmus. Low-voltage extensions can be anticipated but not guaranteed by the presence of visible anastomosis of the VOM with roof or posterior veins.
缺乏对Marshall 静脉（VOM）诱导的组织消融的系统和定量描述。我们旨在描述 VOM 乙醇输注后左心房（LA）中观察到的低电压分布。
在 114 例因房颤消融而转诊的患者中，通过比较 VOM 乙醇输注前后进行的高密度图，评估了乙醇诱导的低电压分布。受影响的两个最常见节段是嵴的下部（82.5%）和二尖瓣峡部的前半部分（肺静脉侧）（92.1%）。在这些典型区域中，低电压缺失是由于左心耳静脉（n=3）、初始 VOM 夹层（n=3）或“无分支”VOM 形态（n=1）中的无意乙醇输注所致。VOM 与房顶或后静脉的可见吻合更常导致低电压向典型区域以外延伸，朝向整个左心房（19.0%比 1.9%，p=0.0045）或后 LA（39.7%比 3.8%，p<0.001），但阳性预测值有限，范围为 29.4%至 43.5%。乙醇诱导的低电压覆盖 LA 表面的中位数为 3.6%（1.9%-5.0%），并且在 90%的患者中，LA 表面的低电压扩展不超过 8%。
VOM 乙醇输注通常位于下嵴和相邻的二尖瓣峡部的一半。通过 VOM 与房顶或后静脉的可见吻合可以预期，但不能保证低电压的延伸。
