Adjunctive Vein of Marshall ethanol infusion increased sinus rhythm maintenance from 48.6% to 65.8% (OR 1.68, HR 0.73) without raising complications in persistent AF ablation.
Does adjunctive Vein of Marshall ethanol infusion improve freedom from atrial fibrillation recurrence in patients undergoing catheter ablation for persistent atrial fibrillation?
Adjunctive Vein of Marshall ethanol infusion significantly improves 1-year sinus rhythm maintenance in patients undergoing catheter ablation for persistent atrial fibrillation, without increasing major complications.
Absolute Event Rate: 0% vs 0%
ABSTRACT Background Catheter ablation for persistent atrial fibrillation (AF) exhibits suboptimal outcomes after pulmonary vein isolation (PVI) alone. The vein of Marshall (VOM) has emerged as an adjunctive ablation target, through which ethanol infusion can achieve transmural lesions in regions resistant to radiofrequency ablation. Objective To evaluate the efficacy and safety of adjunctive VOM ethanol infusion in patients undergoing catheter ablation for persistent AF. Methods We conducted a meta‐analysis of randomized controlled trials (RCTs) comparing PVI ± linear ablation with versus without VOM ethanol infusion for persistent AF. The primary outcome was freedom from AF recurrence, analyzed using odds ratios and hazard ratios for time‐to‐event data. Secondary outcomes included procedural metrics and complications. Data were pooled using random‐effects models. Results Four RCTs ( n = 1045 patients) were included. VOM ethanol infusion significantly improved sinus rhythm maintenance (65.8% vs. 48.6%; absolute difference 17.2%; OR: 1.68, 95% CI: 1.13–2.49, p = 0.025). Time‐to‐event analysis showed consistent benefit of maintaining sinus rhythm during the first post‐procedure year (pooled HR: 0.73, 95% CI: 0.59–0.91, p = 0.005) with high mitral isthmus block rates (90%). Subgroup analysis showed consistent sinus rhythm maintenance whether ethanol was added to PVI alone (OR: 1.66) or PVI with linear ablation (OR: 1.69). Fluoroscopy time was longer (+10.3 min, p = 0.0009) with VOM ethanol infusion. Complication rates were similar (OR: 1.55, p = 0.46). Conclusion Adjunctive VOM ethanol infusion significantly improves ablation outcomes in persistent AF without increasing major complications. It represents a promising strategy to enhance durable rhythm control. Further research is required to evaluate long‐term outcomes.
Zhang et al. (Fri,) reported a other. Adjunctive Vein of Marshall ethanol infusion increased sinus rhythm maintenance from 48.6% to 65.8% (OR 1.68, HR 0.73) without raising complications in persistent AF ablation.