Why the study?
Intrinsic cardiac nerves (ICN) cluster around the left atrial epicardium and are implicated in the genesis of AF, but whether ethanol infusion in the VOM can ablate ICN was unknown.
Does ethanol infusion in the vein of Marshall eliminate parasympathetic responses in patients undergoing atrial fibrillation ablation?
Population
Patients undergoing catheter AF ablation (n=8 SynchHFS, n=72 BurstHFS)
Comparison
Before vs after VOM ethanol infusion
Design
Prospective interventional study
Key result
Retrograde ethanol infusion in the vein of Marshall abolished local parasympathetic responses in 100% of patients undergoing atrial fibrillation ablation.
Authors
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Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“This is a therapy that targets cardiac nerves previously shown to be involved in atrial fibrillation. Radiofrequency ablation carries risks of collateral damage to other structures and there are also risks associated with surgical approaches. We show that chemical ablation with alcohol can achieve elimination of abnormal nerve activity, introducing a catheter through a neck vein and doing all the work through it.”
“the VOM is absent or too small to be cannulated in some patients, potentially increasing procedure time”
May attenuate ICN activity during AF ablation; hypothesis-generating and requires randomized trials before practice change.
Does ethanol infusion in the vein of Marshall eliminate parasympathetic responses in patients undergoing atrial fibrillation ablation?
Retrograde ethanol infusion in the vein of Marshall reliably eliminates local intrinsic cardiac nerve responses, offering a targeted vascular approach for parasympathetic denervation during AF ablation.
Báez-Escudero et al. (2014) studied Atrial fibrillation (n=80). Ethanol infusion in the vein of Marshall was evaluated on Parasympathetic responses (AV nodal conduction slowing). Retrograde ethanol infusion in the vein of Marshall abolished local parasympathetic responses in 100% of patients undergoing atrial fibrillation ablation.