One potential approach is to target the vein of Marshall (VOM), which traverses the epicardial aspect of the MI. However, achieving bidirectional conduction block poses technical challenges due to its anatomical complexity and epicardial electrical connections. The mitral isthmus (MI), involving the left inferior pulmonary vein (LIPV), Left atrial appendage (LAA), coronary sinus (CS), ligament of Marshall (LOM), and mitral annulus (MA), is a critical structure for minimizing the recurrence of PeAF. In recent years, more extensive ablations have been advocated to improve the success rate of PeAF catheter ablation, including linear ablation, complex fractioned electrograms, and so on. ![]() Our novel stepwise catheter ablation method for MI yielded a high bidirectional block rate with high reproducibility.Īlthough pulmonary vein isolation (PVI) remains the cornerstone of catheter ablation for atrial fibrillation (AF), it may not be sufficient to sustain sinus rhythm in persistent AF (PeAF) patients. No patient experienced fatal complications. The block rates of every step were 0%, 58.0%, 44.0%, and 92.9%, and the cumulative block rates for the four steps were 0%, 58.0%, 76.5%, and 98.3%, respectively. Bidirectional conduction blocks were achieved in 117 patients (98.3%). Resultsġ35 patients with PeAF underwent catheter ablation with the stepwise ablation method adopted in 119 cases. In step 4, precise epicardial ablation was performed, with the catheter introduced into the coronary sinus(CS) to target key ablation targets (KATs). In step 3, earliest activation sites(EASs) near the ablation line were identified using activation mapping followed by reinforced ablation. In step 2, a “V-shape” endocardial linear ablation connecting the left inferior pulmonary vein (LIPV) to mitral annulus (MA) was performed. In step 1, ethanol infusion of the vein of Marshall (EI-VOM) was performed. The MI ablation procedure followed a stepwise approach. MethodsĬonsecutive patients with persistent atrial fibrillation (PeAF) that underwent catheter ablation were included. This study aimed to introduce and evaluate a novel ablation method of MI. According to the literature, the success rate of achieving a bidirectional conduction block across the MI ranges from 51 to 96%, with no standardized strategy or method available for cardiac electrophysiologists. Neurohemodynamic correlates of ‘OM’ chanting: A pilot functional magnetic resonance imaging study.Ethanol infusion of the vein of Marshall (EI-VOM) has been widely used to facilitate mitral isthmus (MI) ablation.
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