Enhancing ablation outcomes: vein of Marshall ethanol infusion in persistent atrial fibrillation with severe left atrial enlargement

Figures

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  Figure 1. The main steps involved in the VOM-EI process. (A) An angiography of the CS vein demonstrated the presence of the VOM (see red arrow). (B) By inserting a guidewire (shown by the red arrow), the distal section of the VOM could be accessed. (C) Anhydrous ethanol was injected through the balloon catheter inflated at the distal segment of the VOM (red arrow indicating inflated balloon catheter). (D) The ablated myocardium can be colored with contrast agents by multiple injections of anhydrous ethanol (The red arrow indicates the contrast agents).

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  Figure 2. The typical LA voltage maps at baseline and after the VOM-EI procedure. The baseline LA voltage in left lateral (LL) and posteroanterior (PA) views, respectively (A,B). After the VOM-EI procedure, the LA voltage shows a larger LVA, mainly located in the left atrial appendage (LAA)- the left inferior pulmonary vein (LIPV), the posterior wall of the left pulmonary vein, and the mitral isthmus (MI) in LL and PA views, respectively (C,D). LSPV stands for left superior pulmonary vein, RSPV stands for right superior pulmonary vein, and RIPV stands for right inferior pulmonary vein.

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  Figure 3. The typical LA maps after CPVA ablation, roof ablation, and posterior MI ablation. Following CPVA and linear ablation of the roof and posterior MI, the typical LA maps are shown in the left lateral and posteroanterior views, respectively (A,B). The abbreviations LSPV, RSPV, LIPV, and RIPV correspond to the left superior, right superior, left inferior, and right inferior pulmonary veins, respectively, with MI and LAA standing for the mitral isthmus and left atrial appendage.

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  Figure 4. Twelve-month survival curve for patients without recurrence of AF.