Key result
PVI plus VoM ethanol ablation linked to ~54% lower AF recurrence versus PVI alone.
Why the study?
Does Vein of Marshall ethanol or radiofrequency ablation added to PVI and substrate modification reduce arrhythmia recurrence in patients with persistent atrial fibrillation undergoing de novo ablation?
Observational (n=746)
Yes
Does Vein of Marshall ethanol or radiofrequency ablation added to PVI and substrate modification reduce arrhythmia recurrence in patients with persistent atrial fibrillation undergoing de novo ablation?
Vein of Marshall ethanol ablation as an adjunct to PVI and substrate modification is safe and significantly reduces arrhythmia recurrence at 12 months in patients with persistent atrial fibrillation compared to PVI alone or PVI with VoM radiofrequency ablation.
Answers are grounded in this paper and cite their sources.
Supports adjunctive VOM ethanol ablation to PVI in persistent AF; extends real-world evidence but leaves open randomized confirmation.
BACKGROUND: Strategies for persistent atrial fibrillation (PsAF) ablation remain limited. OBJECTIVE: This study aimed to determine optimal PsAF ablation strategies. METHODS: REAL-AF (NCT04088971) is a multicenter, prospective, observational registry enrolling patients undergoing de novo ablation for atrial fibrillation. Between January 2018 and August 2024, 746 patients with PsAF were treated with radiofrequency ablation (RFA); 3 ablation methods were analyzed: group 1, pulmonary vein isolation (PVI) only; group 2, PVI + substrate modification (SM) + vein of Marshall (VoM) by RFA; and group 3, PVI + SM + VoM by ethanol (EtOH). RESULTS: Of the overall 746 patients, 564 patients (75.6%) were treated with PVI only (group 1), 94 (12.6%) with PVI + SM + VoM RFA (group 2), and 88 (11.8%) with PVI + SM + VoM EtOH (group 3). Scar burden was higher in group 2 than groups 1 or 3 (20%, 1.0%, and 11%, respectively; P < .001). Procedure times were higher in group 3 (147 minutes; interquartile range 125.0-171.0) than groups 1 (81.0 minutes; 64.0-104.0) and 2 (90.5 minutes; 64.8-119.3). Acute complication rates were low in all groups, lowest in group 3 (0%; P = .438), and 12-month rates remained lowest in group 3 (2.3%; P = .896). Arrhythmia recurrence was reduced in group 3 through 12 months (15.3%) vs groups 1 (24.4%) and 2 (35.3%) (P = .023). Repeat ablations through 12 months trended lowest in group 3 (3.4%) vs groups 1 (5.3%) and 2 (6.4%) (P = .654). CONCLUSION: VoM EtOH ablation for PsAF seems safe and efficacious as an adjunctive strategy for the treatment of PsAF. Findings are not based on cohort size, but on comparative effectiveness and safety across distinct ablation strategies in real-world practice.
No takes yet. Share an insight, caveat, or question.
Palmeri et al. (2026) conducted an observational in persistent atrial fibrillation (PsAF) (n=746). PVI + SM + VoM by ethanol (EtOH) vs. PVI only and PVI + SM + VoM by RFA was evaluated on Arrhythmia recurrence through 12 months (p=0.023). Vein of Marshall ethanol ablation reduced 12-month arrhythmia recurrence (15.3%) compared to PVI only (24.4%) and PVI with VoM radiofrequency ablation (35.3%) (P=0.023).
Synapse has enriched 10 related papers. Consider them for comparative context: