JACC. Case reports · 2026
Ethanol Infusion of Atrial Flutter Mediated by the Vein of Marshall.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Zhao Xiaohua, Guo Fuding, Yang Sen, Yang Jing, He Chende, Lu Mei, Li Mengmeng, Long Deyong, Li Shaolong, Liao Qiwei
Аннотация
BACKGROUND: Atypical atrial flutter (AFL) after atrial fibrillation (AF) ablation, particularly when mediated by epicardial structures such as the vein of Marshall (VOM), poses a therapeutic challenge.
CASE SUMMARY: A 64-year-old woman presented with recurrent AFL after AF ablation. High-density and entrainment mapping confirmed a macro-re-entrant circuit involving the VOM via epicardial conduction. After failed endocardial ablation, ethanol infusion into the VOM immediately terminated the tachycardia. At 1-year follow-up, the patient maintained sinus rhythm with a marked improvement in left ventricular ejection fraction (from 46% to 68%).
DISCUSSION: For postablation AFL, comprehensive mapping is crucial to identify epicardial substrates. VOM-mediated flutter can be effectively treated with ethanol infusion.
TAKE-HOME MESSAGE: This case underscores that VOM-mediated epicardial connections can sustain AFL after AF ablation, and targeted ethanol infusion is a highly effective therapeutic strategy.
CASE SUMMARY: A 64-year-old woman presented with recurrent AFL after AF ablation. High-density and entrainment mapping confirmed a macro-re-entrant circuit involving the VOM via epicardial conduction. After failed endocardial ablation, ethanol infusion into the VOM immediately terminated the tachycardia. At 1-year follow-up, the patient maintained sinus rhythm with a marked improvement in left ventricular ejection fraction (from 46% to 68%).
DISCUSSION: For postablation AFL, comprehensive mapping is crucial to identify epicardial substrates. VOM-mediated flutter can be effectively treated with ethanol infusion.
TAKE-HOME MESSAGE: This case underscores that VOM-mediated epicardial connections can sustain AFL after AF ablation, and targeted ethanol infusion is a highly effective therapeutic strategy.