Chemical mapping as a predictor of vein of Marshall ethanol ablative effects

• Published in: Pacing and clinical electrophysiology 2020-01, Vol.43 (1), p.47-53
• Main Authors: Okishige, Kaoru, Shigeta, Takatoshi, Nishimura, Takuro, Nakamura, Rena A., Hirao, Tatsuhiko, Yoshida, Hiroshi, Yamauchi, Yasuteru, Keida, Takehiko, Sasano, Tetsuo, Hirao, Kenzo, Valderrábano, Miguel
• Format: Article
• Language: English
• Subjects: Aged; Anti-Arrhythmia Agents - pharmacology; Antiarrhythmic agents; atrial fibrillation; Atrial Fibrillation - therapy; Cardiac arrhythmia; Catheter Ablation - methods; chemical ablation; cibenzoline; Contrast Media; Coronary Angiography; Coronary Vessels; Electrocardiography; Ethanol; Ethanol - pharmacology; Female; Fibrillation; Fluoroscopy; Humans; Imidazoles - pharmacology; Infusions, Intravenous; Male; Mapping; Marshall vein; Middle Aged; Phlebography
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/pace.13839

Purpose The aim of this study was to test regional pharmacological effects of an antiarrhythmic agents to predict ablative effects. Background The vein of Marshall (VOM) providing vascular access to myocardial tissue has been used for ablative purposes using ethanol. Methods A total of 35 patients (male 21, 63.2 ± 7.8 years old) were included. A balloon‐tipped infusion catheter was inserted into the VOM. Endocardial ultrahigh‐resolution mapping was performed along the VOM region to record the change in atrial electrograms (AEs) after VOM injection of cibenzoline of 3.5 mg during sustained atrial fibrillation (AF). Subsequently, ethanol was infused into the VOM and ablative region was mapped. Results In 17 patients (49 %), cibenzoline reduced AEs amplitude by >50%, all of which had also complete elimination of AEs following ethanol (Group A). In 18 patients (Group B), cibenzoline failed to eliminate AEs; yet, in 13 of 18 AEs were eliminated by ethanol. In the remaining five patients, ethanol did not eliminate AE. Conclusions Cibenzoline into the VOM could reliably predicts the results of subsequent ethanol infusion into the VOM using ultrahigh‐resolution mapping system, which leads to avoid unnecessary permanent lesion creation by ethanol infusion.