Ethanol infusion in the vein of Marshall: A potential bail-out strategy in cardioneuromodulation procedures?

Figures

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  Figure 1. a: Tracing showing some of the episodes of sinus node arrest/nodal rhythm. b: Episodes of atrial fibrillation preablation. c: Right anterior oblique view depicting the radiofrequency (RF) lesions applied at the level of the superior vena cava–ganglia plexus (medial lower part of vena cava). d: Right anterior oblique view illustrating the RF applications in the left atrium. e: Simultaneous view of right and left applications.

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  Figure 2. a: Voltage map of the left atrium (cut-off 0.20–0.50 mV) at the time of the procedure in atrial flutter rhythm. b: Venogram of the vein of Marshall (arrow). c: Electroanatomical map (left atrium lateral view) after venous ethanol ablation and focal radiofrequency endocardial applications at the annular level.

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  Figure 3. a: Pacemaker interrogation performed 3 months after vein of Marshall ethanol infusion (red arrow) showing atrial tachycardia burden (yellow asterisk) 2 months after the first ablation (December 2021) with the significant reduction in atrial pacing immediately after the second procedure: a.1: total time in atrial tachycardia; a.2: heart rate during atrial tachycardia; a.3: percentage of atrial and ventricular pacing; a.4: mean ventricular heart rate (day and night, respectively); a.5: patient activity (in hours); a.6: heart rate variability.