Journal Article

Double-wire technique to facilitate vein of Marshall cannulation and ethanol infusion in atrial fibrillation: a case series

Lei Ding, Hong-Da Zhang, Li-Jie Mi, Kuo Zhang, Feng-Yuan Yu, Zi-Han Jiang, Min Tang, Si-Xian Weng

2023

Overview

Background The vein of Marshall (VOM) ethanol infusion is increasingly performed in combination with catheter ablation in atrial fibrillation (AF). The cannulation of the VOM can sometimes be challenging. This study aimed to evaluate the double-wire technique in cases of difficult cannulation of the VOM. Case presentation Patients with AF scheduled for combined catheter ablation and VOM ethanol infusion were consecutively enrolled. The procedure was performed via the femoral vein. If the regular cannulation technique with one angioplasty wire failed or took more than 20 min, the double-wire technique using a stabilizing wire and a cannulation wire was performed. The unique technique was used mainly in two scenarios, when the Eustachian ridge was too prominent as a barrier for catheter manipulation or when the VOM ostium was close to the coronary sinus ostium. Of 162 patients scheduled for VOM ethanol infusion, the double-wire technique was applied in 6 (3.7%) patients and led to a 100% successful cannulation rate of the VOM. Of the six patients, two had a prominent Eustachian ridge, and four had a VOM ostium close to the coronary sinus ostium. The mean cannulation time was 33.3 ± 7.3 min. The ethanol infusion was successfully performed in 5 patients. One patient had a collateral circulation in the distal VOM, and ethanol infusion was not performed. Conclusions The double-wire technique can facilitate VOM cannulation and ethanol infusion in challenging cases. Word count : 231.

• Publisher: Springer Science and Business Media LLC,BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Ablation / Ablation (Surgery) / Acetaldehyde / Alcohol / Alcohol, Denatured / Angiology / Angioplasty / Atrial fibrillation / Blood Transfusion Medicine / Cannulation / Cardiac arrhythmia / Cardiac Surgery / Cardiology / Care and treatment / Case report / Catheter Ablation / Catheterization / Catheters / Complications and side effects / Coronary Sinus / Coronary Vessels / Diagnosis / Diseases of the circulatory (Cardiovascular) system / Ethanol / Ethanol infusion / Fibrillation / Health aspects / Humans / Internal Medicine / Medical imaging / Medicine / Medicine & Public Health / Methods / Oxygen equipment (Medical care) / Patients / RC666-701 / Superior vena cava syndrome / The vein of Marshall / Veins & arteries / Wire