Chemical mapping as a predictor of vein of Marshall ethanol ablative effects

Kaoru Okishige, Takatoshi Shigeta, Takuro Nishimura, Rena A. Nakamura, Tatsuhiko Hirao, Hiroshi Yoshida, Yasuteru Yamauchi, Takehiko Keida, Tetsuo Sasano, Kenzo Hirao, Miguel Valderrábano

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Purpose: The aim of this study was to test regional pharmacological effects of an antiarrhythmic agents to predict ablative effects. Background: The vein of Marshall (VOM) providing vascular access to myocardial tissue has been used for ablative purposes using ethanol. Methods: A total of 35 patients (male 21, 63.2 ± 7.8 years old) were included. A balloon-tipped infusion catheter was inserted into the VOM. Endocardial ultrahigh-resolution mapping was performed along the VOM region to record the change in atrial electrograms (AEs) after VOM injection of cibenzoline of 3.5 mg during sustained atrial fibrillation (AF). Subsequently, ethanol was infused into the VOM and ablative region was mapped. Results: In 17 patients (49 %), cibenzoline reduced AEs amplitude by >50%, all of which had also complete elimination of AEs following ethanol (Group A). In 18 patients (Group B), cibenzoline failed to eliminate AEs; yet, in 13 of 18 AEs were eliminated by ethanol. In the remaining five patients, ethanol did not eliminate AE. Conclusions: Cibenzoline into the VOM could reliably predicts the results of subsequent ethanol infusion into the VOM using ultrahigh-resolution mapping system, which leads to avoid unnecessary permanent lesion creation by ethanol infusion.

Original languageEnglish (US)
Pages (from-to)47-53
Number of pages7
JournalPACE - Pacing and Clinical Electrophysiology
Issue number1
StatePublished - Jan 1 2020


  • Marshall vein
  • atrial fibrillation
  • chemical ablation
  • cibenzoline
  • Humans
  • Middle Aged
  • Ethanol/pharmacology
  • Catheter Ablation/methods
  • Male
  • Fluoroscopy
  • Anti-Arrhythmia Agents/pharmacology
  • Coronary Vessels
  • Phlebography
  • Coronary Angiography
  • Atrial Fibrillation/therapy
  • Contrast Media
  • Imidazoles/pharmacology
  • Electrocardiography
  • Female
  • Aged
  • Infusions, Intravenous

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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