A New Strategy for Mitral Isthmus Line Block: Marshall Ligament Alcohol Ablation Combined with Radiofrequency Ablation Synergistic Intervention

'2C3L' as a classic ablation strategy is widely used in persistent CAF. It originated from the classic surgical Cox-maze procedure. Based on PV isolation, further intervention Stagnation line, mitral valve isthmus line, and tricuspid valve isthmus line. Taking additional linear ablation can effectively solve and prevent postoperative atrial flutter. ensure the consistency and effectiveness of the ablation strategy.

However, in the actual operation process, due to its absence of a natural tissue anatomical barrier the mitral valve isthmus is difficult to completely block during the ablation process. At present, our center found that the mitral valve isthmus line is difficult to block because it may have a connection with the epicardium. On this basis, explore the effect of the possible epicardial insertion point of ligament on mitral valve isthmus block.

The Marshall ligament (LOM) is a bundle of epicardial structures extending from the coronary sinus to the mouth of the left upper pulmonary vein, including the Marshall vein, myocardial cuff, and autonomic nerves.

Based on the above, we adopt a combination of endocardial and adventitial ablation strategies to intervene in the mitral valve isthmus: on the epicardial surface of the mitral valve isthmus, multiple doses of absolute ethanol (2 mL per time) were used Alcohol ablation was performed on the distal Marshall vein, meanwhile the ablation catheter was used to linearly ablate the endometrial surface. The results of central clinical studies showed that combined ablation can effectively increase the success rate of mitral valve isthmus block and the overall success rate of CAF.