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

JACC Clin Electrophysiol. 2022 Feb;8(2):168-178. doi: 10.1016/j.jacep.2021.09.020. Epub 2021 Nov 24.


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 postero-superiorly 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.

Keywords: ablation; computed tomography; ethanol infusion into the vein of Marshall; vein of Marshall.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Catheter Ablation* / methods
  • Ethanol*
  • Humans
  • Infusions, Intravenous
  • Tomography
  • Tomography, X-Ray Computed


  • Ethanol