TY - JOUR
T1 - Ethanol infusion in the vein of marshall leads to parasympathetic denervation of the human left atrium
T2 - Implications for atrial fibrillation
AU - Báez-Escudero, José L.
AU - Keida, Takehiko
AU - Dave, Amish S.
AU - Okishige, Kaoru
AU - Valderrábano, Miguel
N1 - Funding Information:
Dr. Valderrábano is supported by National Institutes of Health/National Heart, Lung, and Blood Institute grants R21HL097305 and R01 HL115003 . Dr. Báez-Escudero is a consultant and speaker for St. Jude Medical and Biosense Webster; and the Antonio Pacifico, MD, fellowship in electrophysiology (to Dr. Báez-Escudero). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2014/5/13
Y1 - 2014/5/13
N2 - Objectives This study sought to determine whether ethanol infusion in the vein of Marshall (VOM) can ablate intrinsic cardiac nerves (ICN). Background ICN cluster around the left atrial epicardium and are implicated in the genesis of atrial fibrillation (AF). Methods Patients undergoing catheter AF ablation underwent adjunctive ethanol injection in the VOM. A multipolar catheter was introduced in the VOM and used for high-frequency stimulation (HFS), either as HFS with P-wave synchronized (SynchHFS), 30 pulses, 100 Hz (n = 8) or as HFS with 3 to 10 s bursts (BurstHFS), 33 Hz (n = 72) at 25 mA for 1-ms duration. Atrioventricular (AV) nodal conduction slowing (asystole >2 s or R-R interval prolongation >50%) and AF inducibility were assessed before and after VOM ethanol infusion. Up to 4 1-ml infusions of 98% ethanol were delivered via an angioplasty balloon in the VOM. Results SynchHFS induced AF in 8 of 8 patients. In 4 of 8 AF initiated spontaneously without VOM capture. No parasympathetic responses were elicited by SynchHFS. BurstHFS was performed in 32 patients undergoing de novo AF ablation (Group 1) and 40 patients undergoing repeat ablation (Group 2). Parasympathetic responses were found in all 32 Group 1 patients and in 75% of Group 2 patients. After VOM ethanol infusion, parasympathetic responses were abolished in all patients (both groups). There were no acute complications related to VOM ethanol infusion. Conclusions The VOM contains ICN that connect with the AV node and can trigger AF. Retrograde ethanol infusion in the VOM reliably eliminates local ICN responses. The VOM is a vascular route for ICN-targeting therapies.
AB - Objectives This study sought to determine whether ethanol infusion in the vein of Marshall (VOM) can ablate intrinsic cardiac nerves (ICN). Background ICN cluster around the left atrial epicardium and are implicated in the genesis of atrial fibrillation (AF). Methods Patients undergoing catheter AF ablation underwent adjunctive ethanol injection in the VOM. A multipolar catheter was introduced in the VOM and used for high-frequency stimulation (HFS), either as HFS with P-wave synchronized (SynchHFS), 30 pulses, 100 Hz (n = 8) or as HFS with 3 to 10 s bursts (BurstHFS), 33 Hz (n = 72) at 25 mA for 1-ms duration. Atrioventricular (AV) nodal conduction slowing (asystole >2 s or R-R interval prolongation >50%) and AF inducibility were assessed before and after VOM ethanol infusion. Up to 4 1-ml infusions of 98% ethanol were delivered via an angioplasty balloon in the VOM. Results SynchHFS induced AF in 8 of 8 patients. In 4 of 8 AF initiated spontaneously without VOM capture. No parasympathetic responses were elicited by SynchHFS. BurstHFS was performed in 32 patients undergoing de novo AF ablation (Group 1) and 40 patients undergoing repeat ablation (Group 2). Parasympathetic responses were found in all 32 Group 1 patients and in 75% of Group 2 patients. After VOM ethanol infusion, parasympathetic responses were abolished in all patients (both groups). There were no acute complications related to VOM ethanol infusion. Conclusions The VOM contains ICN that connect with the AV node and can trigger AF. Retrograde ethanol infusion in the VOM reliably eliminates local ICN responses. The VOM is a vascular route for ICN-targeting therapies.
KW - atrial fibrillation
KW - ethanol
KW - intrinsic cardiac nerves
KW - vein of Marshall
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U2 - 10.1016/j.jacc.2014.01.032
DO - 10.1016/j.jacc.2014.01.032
M3 - Article
C2 - 24561151
AN - SCOPUS:84896939966
SN - 0735-1097
VL - 63
SP - 1892
EP - 1901
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 18
ER -