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Vein of Marshall Procedure Takes Shot at Treating Irregular Heart Rhythms

By Aatish Garg, MD, Cardiologist — Virtua Heart Rhythm Specialists – Cherry Hill

Consuming too many shots of tequila, vodka, or whiskey in one sitting can lead to a bad hangover.

But it turns out a small injection of 100% pure alcohol into a vein running along the external surface of your left atrium can help treat the same irregular rhythms that can increase your risk for blood clots, stroke, and heart failure.

A new treatment now available from Virtua heart rhythm specialists combines a traditional catheter ablation with an infusion of 5 to 10 cc (1 to 2 teaspoons) of alcohol into the “vein of Marshall.”

As we’ve mapped the electrical activity of the heart, we’ve learned the triggers for atrial fibrillation and flutters are usually located within the veins that enter the left and right atria, like the pulmonary veins and coronary sinus, a branch of which is the vein of Marshall.

Out of Rhythm
A normal heartbeat starts with a signal from cells in the upper right chamber of your heart (the right atrium) and travels to the lower chambers (the ventricles), causing the muscle to squeeze and send blood to the body.

If the signals are chaotic, the atria can beat irregularly and out of coordination with the ventricles. This is called atrial fibrillation (AFib).

If there is a “short circuit” in the electrical pathway, the atria can beat regularly, but much faster than the ventricles. This is called atrial flutter.

Both conditions can cause palpitations, fatigue, and shortness of breath, and heighten your risk of heart failure and stroke. Medications may help control these irregular rhythms, but both AFib and atrial flutter are best treated with catheter ablation.

Correcting the Signal
Ablation is performed by threading special catheters through the femoral veins into the heart. The physician uses radiofrequency energy to scar, or “ablate,” the area causing the abnormal rhythm.

Often, those areas area located inside the heart. However, they also can be on the outer surface, which is difficult to reach minimally invasively and may require a surgeon to open the chest to access them.

Following the ablation of the inner surface of the heart, we use another catheter to get into the coronary sinus and then locate the vein of Marshal, which travels on the outer surface of the left atrium. Expanding a special balloon within the vein of Marshall, we inject alcohol into the vein, destroying the tissue causing the irregular heartbeat.

Studies show the vein of Marshall alcohol injection procedure can increase the success rate of catheter ablations by 10 to 15% for persistent atrial fibrillation, and by more than 30% for atrial flutter from the left atrium. This could reduce the need for repeat ablations and cause a significant improvement in patients’ quality of life.

The more we understand the physiology of the heart, we see the triggers for AFib and the circuit for atrial flutters residing within the vein of Marshall, which had been hiding itself along the outer surface of the heart for so long.

Now we have a minimally invasive means to correct it.

Restore Your Rhythm
Virtua’s more than 100 cardiac experts provide comprehensive cardiac care, from medical cardiology to interventional procedures to advanced cardiac surgery. We can get you an appointment within 48 hours. Make an online appointment or call 888-847-8823.

Updated October 25, 2021

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