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.