Balancing Arrhythmia Freedom and Complications: A Single Center Experience with Vein of Marshall Ethanol Infusion as an Adjunct to Catheter Ablation of Atrial Fibrillation

Since the discovery of pulmonary venous triggers,[1](#ref-0001) catheter ablation with pulmonary vein isolation (PVI) has matured as an important therapy for patients with atrial fibrillation (AF). However despite advances in ablation technology, for non-paroxysmal forms of AF, outcomes remain suboptimal with PVI alone.[](#ref-0002)2 , 3 Adjunctive strategies addressing the atrial substrate or targeting of non-pulmonary vein triggers have not shown consistent efficacy across studies and may carry additional complication risks or higher rates of recurrent organized atrial tachycardias. Recently, ethanol infusion into the vein of Marshall (VOM) has gained popularity with the publication of the VENUS randomized trial[4](#ref-0004) and the positive accumulating experience reported from a single center in Bordeaux.[](#ref-0005)5 , 6 However, adoption has been tempered due to the technical requirements of the procedure and unclear dominant mechanism of putative benefit. Thus, more widespread experience is needed to clarify the real-world impact on procedural success. This report aims to describe a single center experience with VOM ethanol infusion over three years, with description of technical approach, associated procedural success rates, and complications.