A novel approach to invisible vein of Marshall: extending the utility of ethanol infusion into the vein of Marshall

Abstract

Abstract Background The utility of ethanol infusion into the vein of Marshall (EIVOM) is limited in patients without a visible vein of Marshall (VOM). Methods Our study included of 232 patients with atrial fibrillation undergoing MI ablation. We initially performed coronary sinus venography using a balloon catheter in all patients to assess VOM characteristics. EIVOM was attempt in those with adequately visible VOMs. In cases where the VOM was not visible, we utilized a guide-wire to locate its entrance, using the intravenous valve as a landmark. Results Venography initially identified the VOM in 140 of 232 patients (60%) (visible VOM group). Within this group, 68 patients (29%) did not require balloon inflation for VOM visualization, while 72 patients (31%), visibility was achieved through balloon inflation. In the remaining 92 patients (39%), the VOM remained invisible even after balloon inflation. Nevertheless, in 13 of these cases, the VOM was successfully located using a landmark technique (invisible VOM group). EIVOM was fully achieved in 96% (147 of 153 patients). Additionally, full MI line blocks were achieved in 91% of (A) the visible VOM group (122 of 134 patients), 92% of (B) the invisible VOM group (12 of 13 patients), and 81% in (C) the EIVOM (-) group (69 of 85 patients) (A vs. B, p = 0.88; A vs. C, p < 0.05; B vs. C, p = 0.32). Conclusion A novel approach to locating invisible VOM extends the clinical utility of EIVOM and potentially improves success rate of MI ablation.Guide-wire insertion into invisible VOM