Key result
Initial VOM ethanol ablation promptly terminates epicardial atrial tachycardia without requiring endocardial radiofrequency.
Why the study?
Critical areas for complex atrial tachycardia ablation can be located deep inside the tissue and cannot always be successfully reached by endocardial ablation.
Does ethanol ablation of the vein of Marshall as a primary strategy terminate Marshall bundle-related atrial tachycardia in a patient with prior failed ablations?
Case Report (n=1)
No
Does ethanol ablation of the vein of Marshall as a primary strategy terminate Marshall bundle-related atrial tachycardia in a patient with prior failed ablations?
Ethanol ablation of the vein of Marshall can be an effective first-line strategy for terminating epicardial atrial tachycardia related to the Marshall bundle, potentially avoiding unnecessary endocardial radiofrequency ablation.
VOM ethanol ablation reached inaccessible sites in this refractory case; hypothesis-generating for post-PVI tachycardia and needs prospective validation.
Electroanatomic mapping guides complex atrial tachycardia ablations; however, challenges may emerge after pulmonary vein isolation. 3D mapping systems can reveal the mechanism of tachycardia and critical areas that need to be ablated. Sometimes, however, these areas may be located deep inside, to the extent that they cannot be successfully reached by endocardial ablation. In this study, we present a unique case of a patient in whom vein of Marshall (VOM) ethanol ablation, a conventional secondary intervention, promptly terminated a Marshall bundle-related atrial tachycardia without further endocardial radiofrequency application, suggesting VOM ethanol ablation as a potential primary strategy.
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Özgeyik et al. (2024) conducted a case report in Left atrial tachycardia (n=1). Ethanol ablation of the vein of Marshall was evaluated on Termination of atrial tachycardia and non-inducibility. Ethanol ablation of the vein of Marshall as an initial intervention promptly terminated an epicardial atrial tachycardia without the need for subsequent endocardial radiofrequency application.
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