Key result
Combined spatio-temporal dispersion ablation and VOM ethanol infusion achieves ~92% 12-month freedom from atrial arrhythmias.
Why the study?
Targeting spatio-temporal dispersion electrograms improves outcomes over standard PVI in persistent AF, but the real-world performance of combining this strategy with adjunctive vein of Marshall ethanol infusion needed evaluation.
Does a combined ablation strategy of spatio-temporal dispersion-based ablation and vein of Marshall ethanol infusion prevent arrhythmia recurrence in patients with atrial fibrillation?
Observational (n=46)
Yes
Does a combined ablation strategy of spatio-temporal dispersion-based ablation and vein of Marshall ethanol infusion prevent arrhythmia recurrence in patients with atrial fibrillation?
A combined strategy of spatio-temporal dispersion-based ablation and vein of Marshall ethanol infusion is safe and associated with a 92% freedom from arrhythmia recurrence at 12 months in patients with predominantly persistent atrial fibrillation.
Background Targeting spatio-temporal dispersion electrogram in atrial fibrillation (AF) has proven superiority to standard pulmonary vein isolation (PVI) in patients with persistent AF (1). Still, adjunctive vein of Marshall (VOM) ethanol infusion presents with potential advantages. Purpose To report real-world outcomes of a combination strategy: tailored spatio-temporal dispersion-based ablation and VOM ethanol infusion. Methods COMRADE-AI is an observational, prospective, non-randomized, multicentre study to evaluate the use of real-world artificial intelligence-guided spatiotemporal dispersion ablation. In the present analysis, patients underwent a de novo radiofrequency catheter ablation with the Tailored-AF workflow (PVI, dispersion ablation and linear ablation at the operator’s discretion) in addition to VOM ethanol infusion. Only clinically significant relapses were considered for the analysis. Results 46 patients were included from two centres in France: mean age 68 ± 6 years, 22% women, 70% hypertension, 23% sleep apnea, 7% prior stroke, 13% cardiomyopathy, BMI: 29.5 ± 3.9 kg/m², CHA2DS2-VASc: 2.6 ± 1.3, LVEF: 53 ± 12%, 91% persistent atrial fibrillation, 50% with EHRA score > III. Successful VOM ethanol infusion was achieved in 44 patients (92%). Among those 44 patients, total procedure time, mapping and ablation times were 126 ± 24 min, 30 ± 12 min and 69 ± 19 min, respectively. Acute AF termination by ablation was achieved in 50% of patients while acute sinus rhythm conversion was obtained by ablation in 48% of patients. During the procedure, 38% of patients were treated for an atrial tachycardia. Three serious adverse events were observed in 3/46 patients (7%). They included two episodes of dyspnea and one pacemaker implantation. Kaplan-Meier estimates of 12-month freedom from any atrial arrhythmia was 92% (95% CI: 83-100). Conclusion Combination of a tailored ablation strategy targeting spatio-temporal dispersion with VOM ethanol infusion in a real-world cohort is safe and associated with high rate of freedom from arrythmia recurrence.
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Voglimacci et al. (2026) conducted an observational in Atrial fibrillation (n=46). Tailored spatio-temporal dispersion-based ablation and vein of Marshall (VOM) ethanol infusion was evaluated on 12-month freedom from any atrial arrhythmia (95% CI 83-100). A combined strategy of spatio-temporal dispersion-based ablation and vein of Marshall ethanol infusion achieved a 12-month freedom from any atrial arrhythmia of 92% (95% CI: 83-100).
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