Key result
PVI plus VoM alcohol ablation linked to ~119% higher arrhythmia recurrence versus PVI plus LAPWI.
Why the study?
Pulmonary vein isolation alone is known to be inadequate for long-term sinus rhythm in persistent AF, leading to various adjunctive strategies.
Does Vein of Marshall alcohol ablation compared to PFA-based left atrial posterior wall isolation improve long-term arrhythmia-free survival in patients with persistent atrial fibrillation undergoing first-time PVI?
Cohort (n=294)
Does Vein of Marshall alcohol ablation compared to PFA-based left atrial posterior wall isolation improve long-term arrhythmia-free survival in patients with persistent atrial fibrillation undergoing first-time PVI?
In patients with persistent AF undergoing first ablation, adjunctive PFA-based LAPWI resulted in significantly better long-term arrhythmia-free survival compared to Vein of Marshall alcohol ablation.
VoM alcohol ablation was associated with higher recurrence; leaves open comparative efficacy versus LAPWI in randomized trials.
Background Pulmonary vein isolation (PVI) alone is known to be not adequate to achieve long-term sinus rhythm in patients with persistent atrial fibrillation (PerAF). Thus, several adjunctive strategies have been tried. Purpose We compared the long-term outcome of PVI + Vein of Marshall alcohol ablation (VoM) vs PVI+ left atrial posterior wall isolation (LAPWI) using pulsed-field energy. Methods This prospective study included consecutive PerAF patients receiving PVI+VoM (group 1) that were propensity score-matched (1: 2.5) with consecutive PerAF patients undergoing pulsed-field ablation (PFA) for PVI+ LAPWI (group 2). It was the first ablation procedure for all. PVI was performed using PFA in both groups. Group 2 received additional PFA-based LAPWI. In group 1, VoM was achieved after cannulating the vein with an angioplasty wire and balloon and delivering 1 cc of 98% ethanol over 2 minutes. VoM ablation was performed prior to catheter ablation. Patients were monitored quarterly with office visits, 7-day Holter, wearable devices such as Apple watch or Kardia and regular self-pulse-checks. Results A total of 84 and 210 matched perAF patients were included in group 1 and 2 respectively. Baseline characteristics of the study population is given in table 1. Patients were followed-up for at least 2 years. At the end of the follow-up, 41 (48.8%) patients from the VoM group and 142 (67.6%) from the LAPWI group remained arrhythmia-free off-antiarrhythmic drugs (p=0.003) (figure 1). Multivariable regression analysis demonstrated VoM alcohol ablation to be a predictor of recurrence (OR = 2.190; 95% CI 1.307 – 3.670; p-value = 0.004) Conclusion In PerAF patients undergoing their first ablation procedure, PFA-based adjunctive LAPWI was demonstrated to have significantly better long-term outcome compared to the vein of Marshall alcohol ablation.
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Mohanty et al. (2026) conducted a cohort in persistent atrial fibrillation (n=294). PVI + Vein of Marshall alcohol ablation vs. PVI + left atrial posterior wall isolation (LAPWI) was evaluated on arrhythmia-free off-antiarrhythmic drugs (OR 2.190, 95% CI 1.307-3.670, p=0.004). PVI plus Vein of Marshall alcohol ablation was associated with lower arrhythmia-free survival compared to PVI plus LAPWI (48.8% vs 67.6%; P=0.003) and higher recurrence (OR 2.190; P=0.004).
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