Adjunctive vein of Marshall ethanol injection with catheter ablation increased the rate of acute mitral isthmus block compared to catheter ablation alone (RR 1.29; 95% CI 1.11-1.50; p=0.0007).
Meta-Analysis (n=2,633)
Does adjunctive vein of Marshall ethanol injection improve the rate of acute bidirectional block of the isthmus of the mitral annulus and reduce arrhythmia recurrence in patients undergoing catheter ablation for persistent atrial fibrillation?
Adjunctive vein of Marshall ethanol injection during catheter ablation for persistent atrial fibrillation significantly improves acute mitral isthmus block and reduces arrhythmia recurrence compared to ablation alone.
Effect estimate: RR 1.29 (95% CI 1.11-1.50)
p-value: p=0.0007
BACKGROUND: Catheter ablation (CA) is currently used to treat persistent atrial fibrillation (PeAF). However, its effectiveness is limited. This study aimed to estimate the effectiveness of the vein of Marshall absolute ethanol injection (VOM-EI) for PeAF ablation. HYPOTHESIS: Adjunctive vein of Marshall ethanol injection (VOM-EI) strategies are more effective than conventional catheter ablation (CA) and have similar safety outcomes. METHODS: We extensively searched the literature for studies evaluating the effectiveness and safety of VOM-EI + CA compared with CA alone. The primary endpoint was the rate of acute bidirectional block of the isthmus of the mitral annulus (MIBB). The secondary endpoints were atrial fibrillation (AF) or atrial tachycardia (AT) recurrence over 30 seconds after a 3-month blanking period. Weighted pooled risk ratios (RRs) and corresponding 95% confidence intervals (CIs) were calculated using a random effects model. RESULTS: Based on the selection criteria, nine studies were included in this systematic review, including patients with AF (n = 2508), persistent AF (n = 1829), perimitral flutter (n = 103), and perimitral AT (n = 165). There were 1028 patients in the VOM-EI + CA group and 1605 in the CA alone group. The VOM-EI + CA group showed a lower rate of AF/AT relapse (RR = 0.70; 95% CI = 0.53-0.91; p = .008) and a higher rate of acute MIBB (RR = 1.29; 95% CI = 1.11-1.50; p = .0007) than the CA alone group. CONCLUSION: Our meta-analysis revealed that adjunctive VOM-EI strategies are more effective than conventional CA and have similar safety outcomes.
Ge et al. (2023) conducted a meta-analysis in Persistent atrial fibrillation (PeAF) (n=2,633). Vein of Marshall absolute ethanol injection (VOM-EI) + catheter ablation (CA) vs. Catheter ablation (CA) alone was evaluated on Rate of acute bidirectional block of the isthmus of the mitral annulus (MIBB) (RR 1.29, 95% CI 1.11-1.50, p=0.0007). Adjunctive vein of Marshall ethanol injection with catheter ablation increased the rate of acute mitral isthmus block compared to catheter ablation alone (RR 1.29; 95% CI 1.11-1.50; p=0.0007).