Miguel Valderrábano1, Percy Francisco Morales2, Moisés Rodríguez-Mañero2, Candela Lloves2, Paul A Schurmann2, Amish S Dave2. 1. Division of Cardiac Electrophysiology, Methodist DeBakey Heart and Vascular Center and Houston Methodist Hospital, Houston, Texas. Electronic address: mvalderrabano@houstonmethodist.org. 2. Division of Cardiac Electrophysiology, Methodist DeBakey Heart and Vascular Center and Houston Methodist Hospital, Houston, Texas.
Abstract
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.
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.
Authors: Adi Lador; Leif E Peterson; Vijay Swarup; Paul A Schurmann; Akash Makkar; Rahul N Doshi; David DeLurgio; Charles A Athill; Kenneth A Ellenbogen; Andrea Natale; Jayanthi Koneru; Amish S Dave; Irakli Giorgberidze; Hamid Afshar; Michelle L Guthrie; Raquel Bunge; Carlos A Morillo; Neal S Kleiman; Miguel Valderrábano Journal: Heart Rhythm Date: 2021-01-19 Impact factor: 6.779