TY - JOUR
T1 - The Human Left Atrial Venous Circulation as a Vascular Route for Atrial Pharmacological Therapies.
T2 - Effects of Ethanol Infusion
AU - Valderrábano, Miguel
AU - Morales, Percy Francisco
AU - Rodríguez-Mañero, Moisés
AU - Lloves, Candela
AU - Schurmann, Paul A.
AU - Dave, Amish S.
N1 - Publisher Copyright:
© 2017 American College of Cardiology Foundation
Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2017/9
Y1 - 2017/9
N2 - Objectives This study catalogued the human venous left atrium (LA) circulation system and the ablative effects of ethanol in different branches. Background Vascular routes to target the LA could have significant therapeutic potential. Beyond the vein of Marshall (VOM), the fluoroscopic LA venous anatomy has not been described. Methods Patients undergoing ethanol infusion in the VOM as adjunctive therapy to atrial fibrillation (AF) catheter ablation were included in this study. Balloon occlusion venograms of the VOM and other LA veins were obtained in 218 patients. Results Sequentially from the coronary sinus (CS) ostium, LA veins included: 1) proximal septal vein draining the inferior septum; 2) inferior LA vein in the annular inferior LA; 3) VOM; 4) LA appendage vein; and 4) anterior LA vein. Additionally, venous sinuses not connected to the CS included roof veins and posterior wall veins, which drained into the right and left atria, respectively. Venous connections between LA veins through capillaries and with pulmonary veins were abundant. Extracardiac collateral vessels were present in 38 patients (17.4%). Ethanol infusion in LA veins led to tissue ablation in their corresponding regions. Conclusions The atrial venous anatomy is amenable to selective cannulation. Consistent anatomical patterns are present. Targeting atrial tissues through atrial veins can be used for therapeutic purposes.
AB - Objectives This study catalogued the human venous left atrium (LA) circulation system and the ablative effects of ethanol in different branches. Background Vascular routes to target the LA could have significant therapeutic potential. Beyond the vein of Marshall (VOM), the fluoroscopic LA venous anatomy has not been described. Methods Patients undergoing ethanol infusion in the VOM as adjunctive therapy to atrial fibrillation (AF) catheter ablation were included in this study. Balloon occlusion venograms of the VOM and other LA veins were obtained in 218 patients. Results Sequentially from the coronary sinus (CS) ostium, LA veins included: 1) proximal septal vein draining the inferior septum; 2) inferior LA vein in the annular inferior LA; 3) VOM; 4) LA appendage vein; and 4) anterior LA vein. Additionally, venous sinuses not connected to the CS included roof veins and posterior wall veins, which drained into the right and left atria, respectively. Venous connections between LA veins through capillaries and with pulmonary veins were abundant. Extracardiac collateral vessels were present in 38 patients (17.4%). Ethanol infusion in LA veins led to tissue ablation in their corresponding regions. Conclusions The atrial venous anatomy is amenable to selective cannulation. Consistent anatomical patterns are present. Targeting atrial tissues through atrial veins can be used for therapeutic purposes.
KW - atrial veins
KW - balloon angioplasty
KW - ethanol
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U2 - 10.1016/j.jacep.2017.02.022
DO - 10.1016/j.jacep.2017.02.022
M3 - Article
C2 - 29759706
AN - SCOPUS:85018178581
VL - 3
SP - 1020
EP - 1032
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
SN - 2405-500X
IS - 9
ER -