CASE REPORT article
Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1589051
This article is part of the Research TopicAtrial Fibrillation (AF) in Heart Failure with Preserved Ejection Fraction (HFpEF)View all 4 articles
Effect of Catheter Ablation with Vein of Marshall Ethanol Infusion for Perimitral Flutter in a Patient with Senile Transthyretin Cardiac Amyloidosis: A Case Report
Provisionally accepted
- Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Background: Senile transthyretin cardiac amyloidosis is an underdiagnosed infiltrative cardiomyopathy causing heart failure symptoms in elderly patients. It is associated with a higher incidence of atrial fibrillation and atrial flutter. Case summary: A 75-year-old male patient with senile transthyretin cardiac amyloidosis presented with congestive heart failure (NYHA IV) related to rapid perimitral atrial flutter, causing tachycardia-induced cardiomyopathy with a left ventricular ejection fraction (LVEF) of 25%. He underwent atrial fibrillation voltage-guided ablation with vein of Marshall ethanol infusion to block the mitral isthmus. Left atrial bipolar voltage mapping revealed diffuse and severe left atrial low-voltage areas related to amyloid protein infiltration within the left atrium. After 48-month follow-up, no arrhythmia recurrence was observed. Heart failure symptoms improved significantly (NYHA I-II) with an improved LVEF of approximately 45-50%. Discussion: Diffuse and severe left atrial fibrosis related to amyloid protein infiltration within the left atrium is generally associated with worse catheter ablation outcomes in cardiac amyloidosis patients. This case demonstrated that vein of Marshall ethanol infusion was critical to the success of the catheter ablation procedure, resulting in a better long-term outcome.
Keywords: Bipolar voltage map, Vein of Marshall, Cardiac amyloidosis, Catheter Ablation, Atrial fibrilation
Received: 06 Mar 2025; Accepted: 07 Jul 2025.
Copyright: © 2025 Fitouchi, Ohana, Cardi, Jesel and Marzak. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Simon Fitouchi, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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