Human LA Venous Anatomy and Effects of Ethanol

Study Questions:

What are the human venous left atrium (LA) circulation anatomy and the ablative effects of ethanol in different branches?


The investigators included patients undergoing ethanol infusion in the vein of Marshall (VOM) as an adjunctive to atrial fibrillation catheter ablation in this study. Balloon occlusion venograms of the VOM and other LA veins were obtained in 218 patients.


Sequentially from the coronary sinus (CS) ostium, LA veins included: 1) a proximal septal vein draining the inferior septum; 2) an inferior LA vein in the annular inferior LA; 3) the VOM; 4) an LA appendage vein; 4) an anterior LA vein. Additionally, venous sinuses not connected to the CS included roof veins and posterior wall veins, which drained into the right atrium and LA, respectively. Venous connections between LA veins via capillaries and with pulmonary veins were abundant. Extracardiac collaterals were present in 38 patients (17.4%). Ethanol infusion in LA veins led to tissue ablation in their corresponding regions.


The authors concluded that atrial venous anatomy is amenable to selective cannulation.


This study provides anatomical demonstration of the entire in vivo venous circulation of the LA in humans. Furthermore, it delineates a percutaneous technique to deliver therapeutics to the LA in different regions beyond the VOM. This knowledge may provide the procedural and anatomical basis to use retrograde venous approaches to target atrial tissue with either pharmacological or cellular therapies.

Clinical Topics: Arrhythmias and Clinical EP, Noninvasive Imaging, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Angiography, Nuclear Imaging

Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Atrial Appendage, Balloon Occlusion, Catheter Ablation, Catheterization, Coronary Sinus, Ethanol, Heart Atria, Phlebography

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