PO-05-155 A CASE OF ALCOHOL LEADING TO ISOLATION IN THE ELECTROPHYSIOLOGY LABORATORY

Ligament of Marshall alcohol ablation is a treatment for refractory atrial fibrillation and left flutter. Left appendage (LAA) isolation resulting from LOM has not been described. To describe case which resulted in dissociation reentrant flutter the atria. A middle aged man with history multiple flutters was referred repeat after prior unsuccessful ablations. He previously underwent surgical MAZE 3 endocardial ablations including an anterior mitral line epicardial isthmus without achieving bidirectional block. had recurrent, symptomatic despite therapy dofetilide metoprolol. The patient presented atypical ligament cannulated sequentially injected total 3.8 mL. After first injection, tachycardia abruptly terminated on coronary sinus (CS) catheter rhythm resumed (Figure, blue arrows), though surface ECG showed ongoing small waves red arrows). Subsequent mapping confirmed that isolated remaining right atrium remained (Figure C). Overdrive pacing multipolar LAA demonstrated post-pacing interval within 20 ms tachycardia-cycle length Adenosine administration AV block but no alteration cycle-length. These findings were highly suggestive mechanism. Because 3D limited by dissociated CS rhythms, manual activation performed earliest at superior LAA. RF this site slowing termination. In anteroseptal lateral linear ablation, may isolate This should be recognized when counseling patients planning procedures.