Optimized Computed Tomography Acquisition Protocol for Ethanol Infusion Into the Vein of Marshall

OBJECTIVES This study sought to introduce a computed tomography (CT) protocol for optimal planning of vein of Marshall (VOM) catheterization. BACKGROUND Ethanol infusion into the VOM (Et-VOM) is increasingly used in atrial fibrillation ablation. METHODS Preprocedural CT was performed with either a conventional (conv-CT; n = 132) or an optimized CT protocol (VOM-CT; n = 126) designed for obtaining on a single image both left atrial and coronary sinus (CS) enhancement. The detection rate and anatomical features of the CT-derived VOM were analyzed and the utility of VOM-CT protocol was assessed by comparing the procedural data. RESULTS VOM was detected in 35% in conv-CT versus 63% in VOM-CT (P < 0.001). The VOM-CT protocol did not impair the assessment of left atrial anatomy and appendage patency. In VOM-CT, the detection of the VOM was related to body mass index and width of epicardial space on posterior wall. Mean distance between CS ostium and VOM was 36 +/- 7 mm. Mean VOM diameter was 1.6 +/- 0.3 mm. On the CS circumference, the VOM emerged superiorly in 68% and posterosuperiorly in 32%. Ethanol infusion into the VOM was attempted in 165 patients (77 conv-CT, 70 VOM-CT, and 18 without CT). After registration in CARTO, the VOM segmented on CT matched its location on venography in all cases. As compared with conv-CT and without-CT, procedures guided by VOM-CT showed significantly shorter radiation time, shorter procedure time, lower amount of the contrast medium, and fewer contrast injections to obtain VOM catheterization. CONCLUSIONS The proposed CT protocol allows for improved visualization of the VOM, translating into easier VOM catheterization. (J Am Coll Cardiol EP 2022;8:168-178) (c) 2022 by the American College of Cardiology Foundation.