2.2 | Vein of Marshall ethanol infusion (VOM-EI)
The technique of VOM-EI has been described
elsewhere.10 In brief, we cannulated the CS with an
8.5 Fr steerable sheath (Agilis NXT, Abbott Inc, St. Paul, MN) and
placed a 6‐Fr left internal mammary artery (LIMA) guiding catheter into
the great cardiac vein. In a right anterior oblique view, we performed
angiography to localize the ostium of the VOM. If a suitable VOM was
present, we positioned on an over-the-wire percutaneous coronary
angioplasty balloon (Emerge 1.5-2.5 mm x 8 mm; Boston Scientific) into
the proximal VOM advanced over a preloaded coronary guide-wire (Sion
Blue, Asahi Intecc USA, Inc, Santa Ana, CA). After balloon inflation, we
removed the guidewire and obtained a selective VOM angiography by
injecting contrast through the wire port of the balloon. After ensuring
proximal balloon occlusion and adequate VOM angiography, we slowly
injected 96% ethanol into the VOM over 1-2 minutes. During VOM-EI, we
monitored the cycle length of peri-mitral flutter in patients with
ongoing tachycardia. In case of sinus rhythm, we paced the left atrium
from the left atrial appendage and measured the delay on the decapolar
catheter placed over the mitral isthmus via the great cardiac vein.
After VOM-EI, we performed selective VOM angiography to document
chemical ablation of the VOM.
The following day, we recorded a 12-lead-ECG in all patients and
performed transthoracic echocardiography to rule out pericardial
effusion. We obtained cardiac biomarkers the evening of the procedure
and the following morning.