A Clinical Case of Vein of Marshall Alcohol Ablation for Treatment of Perimitral Flutter in a Patient with Several Unsuccessful Ablation Surgeries in History

INTRODUCTION: Catheter radiofrequency or cryoablation operations in accordance with the existing recommendations are one of the main methods of treatment for atrial fibrillation (AF). However, in some cases, pulmonary vein isolation is not sufficient to effectively control arrhythmia, and linear ablations are required in the left atrium during the operation. Despite increased effectiveness of such ablations to prevent AF recurrences, a significant problem in this group of patients is incisional atrial flutter. The critical zone for incisional left-atrial arrhythmias in the vast majority of patients is the mitral isthmus due to its anatomical and electrophysiological features. At the same time, mitral isthmus ablation is associated with technical difficulties due to thickness of the myocardium in this zone, complex anatomical structure of this region and a cooling effect of blood flow in the circumflex branch of the left coronary artery with the probability of reaching the conduction block in 40%–80% of cases. The operation of alcohol ablation of the mitral isthmus proposed by M. Valdebarano, et al. is an effective additional tool for treating the perimitral atrial flutter and achieving the conduction block in it. The clinical case presented by us shows the effective use of this operation in a patient after several cryo and radiofrequency ablation procedures AF for the treatment of perimitral atrial flutter refractory to other methods. CONCLUSION: Alcohol ablation of the vein of Marshall can be an effective tool for the treatment of perimitral atrial flutter in patients with several past cryo and radiofrequency ablations in the left atrium.