Double-wire technique to facilitate vein of Marshall cannulation and ethanol infusion in atrial fibrillation: a case series

Figures

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  Fig. 1. Flow chart of patient enrollment. AF, atrial fibrillation; VOM, the vein of Marshall

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  Fig. 2. Different scenarios suitable for the regular and double-wire technique. A, the scenario that does not need the double-wire technique; B, the scenario suitable for the double-wire technique because the Eustachian ridge was too prominent as a barrier for catheter manipulation; C, the scenario suitable for the double-wire technique because the VOM ostium was close to the CS ostium. The figures are all shown in the left anterior oblique view. VOM, the vein of Marshall; CS, coronary sinus; CSo, CS ostium; MCV, middle cardiac vein; PLV, posterior lateral vein; ER, the Eustachian ridge. The black arrow indicates the VOM; the yellow arrow indicates the cannulation wire in the VOM; the white arrow indicated the stabilizing wire in the CS; the orange curve indicates the shape of the guiding catheter above the ER

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  Fig. 3. Examples of the double-wire technique. A, the double-wire technique used in a patient with prominent Eustachian ridge. B and C, the double-wire technique used in patients with VOM ostium close to the CS ostium. RAO, right anterior oblique; LAO, left anterior oblique; VOM, the vein of Marshall; CS, coronary sinus. The black arrow indicates the VOM; the yellow arrow indicates the cannulation wire in the VOM; the white arrow indicated the stabilizing wire in the distal CS; the orange curve indicates the shape of the guiding catheter above the ER; the yellow curve indicated a reversed S-shape of the guiding catheter

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  Fig. 4. Procedural process for the double-wire technique. A-C, Coronary vein angiography in the RAO, LAO, and LAO cranial view for VOM identification. D-E, the first wire (the stabilizing wire) and the second wire (the cannulation wire) were seen in the LAO cranial view and verified in the RAO view. F, the angioplasty balloon was advanced in the VOM. G-I, localized staining in the RAO, LAO, and LAO cranial view. The black arrow indicates the VOM; the yellow arrow indicates the cannulation wire in the VOM; the white arrow indicated the stabilizing wire in the distal CS; the yellow circle indicates the localized staining

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  Fig. 5. The angiography of patients with successful ethanol infusion. A-E, angiography of the five patients (Patients No. 1, 3, 4, 5, and 6) with successful ethanol infusion. RAO, right anterior oblique; LAO, left anterior oblique. The black arrow indicates the VOM; the white arrow indicated the stabilizing wire in distal CS; the yellow circle indicates the localized staining