Introduction
The vein and ligament of Marshall (VOM and LOM) are associated with
arrhythmogenic roles in atrial fibrillation (AF).1-3It is now well known that sympathetic and parasympathetic nerves promote
a non-pulmonary vein trigger from the VOM and LOM, and that they
contribute to AF maintenance.4,5 The VOM and LOM are
also associated with atrial tachyarrhythmia which develops in the
context of AF ablation as an epicardial conduction pathway of the
macro-reentry and localized reentry circuits.6,7Particularly, mitral annular flutter (MAF)—using the VOM and LOM—is
often observed after AF ablation. It can be technically difficult to
terminate MAF and create a complete block line in the mitral isthmus
(MI) only by radiofrequency (RF) ablation at the endocardium and
coronary sinus (CS).8-10
It is established that ethanol infusion in the VOM (EIVOM) is safe and
effective for creating a linear ablation lesion in the MI and for
ablating MAF using the VOM.11,12 EIVOM is recognized
as an adjunctive strategy of MI ablation which is refractory to RF.
Moreover, previous studies have demonstrated that EIVOM provides good
outcomes in patients with both paroxysmal AF and non-paroxysmal AF and
MAF.13-14 However, few studies have reported on the
actual reconnection rate of MI block line in the distant period remains.
This study was conducted to reveal the long-term outcomes of MI line
block with and without EIVOM.