Adjunctive ethanol instillation into the vein of Marshall improves clinical outcomes in persistent atrial fibrillation patients beyond pulmonary vein isolation.
Does adjunctive ethanol instillation into the vein of Marshall improve clinical outcomes in patients with persistent atrial fibrillation in the era of pulsed-field ablation?
This review highlights the consistent clinical benefit of adjunctive ethanol instillation into the vein of Marshall for persistent atrial fibrillation and evaluates its ongoing relevance alongside emerging pulsed-field ablation technologies.
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Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide and is associated with significant morbidity, mortality, and health care expenditure. Catheter ablation is the most effective treatment strategy to decrease AF burden, a measure strongly correlated with significant clinical outcomes. For the last two decades, pulmonary vein isolation (PVI) has remained the cornerstone of the ablation procedure, with single procedure success rates as high as 90% in patients with paroxysmal AF. These favorable outcomes have not translated to patients with persistent AF, who harbor more atrial remodeling and who may require ablation beyond PVI. While most PVI-adjunctive ablation strategies have not survived the rigor of randomized control trials, in 2020, VENUS showed that adjunctive ethanol instillation into the vein of Marshall (EIVOM) improved clinical outcomes in patients with persistent AF. Since VENUS, three other randomized trials have consistently shown a benefit of adjunctive EIVOM, though utilization of this technique remains low due to a multitude of factors. In parallel to the mounting evidence supporting EIVOM, pulsed-field ablation (PFA) has revolutionized the landscape and has called into question the ongoing role of EIVOM. This review examines the electrophysiologic significance of the VOM and summarizes the clinical evidence supporting adjunctive EIVOM in the era of PFA.
Shah et al. (Sat,) reported a other. Adjunctive ethanol instillation into the vein of Marshall improves clinical outcomes in persistent atrial fibrillation patients beyond pulmonary vein isolation.