Feasibility, safety, and efficacy of vein of marshall ethanol infusion for persistent atrial fibrillation ablation

Introduction Despite limited evidence, two-thirds of physicians perform persistent atrial fibrillation (AF) ablation beyond pulmonary veins isolation. Recent trials and meta-analyses have shown that vein of Marshall (VoM) ethanol infusion provides additional benefit, consistent with the findings in the VENUS trial. Methods and purpose Single-center, retrospective, observational study of patients referred for first procedure radiofrequency (RF) catheter ablation between August 2022 and August 2024. All redo-procedures were excluded. We aimed to assess the feasibility, safety, and efficacy of VoM ethanol infusion for persistent AF ablation. Results A total of 100 patients were included (70% male, mean age of 62±11years). Vein of Marshall (VoM) ethanol infusion was attempted in 43 patients and was successfully achieved in 37 patients (86%). Infusion was unsuccessful in 6 cases: the VoM could not be identified in 4 patients, cannulation wasn’t possible in 1, and dissection of the vein occurred in another. One complication occurred in the VoM group (a mild-to-moderate pericardial effusion), while an esophagitis was reported in the group that not performed VoM ethanol infusion. Both cases were managed conservatively At 1 year follow-up, 21 patients had recurrence of sustained atrial arrhythmia. Overall, single-procedure freedom from atrial arrhythmia was 79%. The risk of recurrence was significantly lower in the VoM group (8.5% vs 28.1%, p=0.021). After adjustment for all univariate predictors, VoM remained independently associated with freedom from atrial arrhythmia at 1 year follow-up (HR of 0.28 (95% CI, 0.08-0.96), p=0.021). Conclusion The VoM ethanol infusion seem to be a feasible, safe and effective approach for persistent AF ablation.