Key result
Vein of Marshall ethanol infusion linked to ~43% less mitral isthmus conduction recovery vs RF alone.
Why the study?
While combined vein of Marshall ethanol infusion and radiofrequency ablation improves acute LPV isolation and posterior mitral isthmus block in non-PAF ablation, its long-term efficacy remains unclear.
Does combined vein of Marshall ethanol infusion and radiofrequency ablation reduce conduction recovery at the left pulmonary vein and mitral isthmus in nonparoxysmal AF patients?
Cohort (n=91)
Yes
Does combined vein of Marshall ethanol infusion and radiofrequency ablation reduce conduction recovery at the left pulmonary vein and mitral isthmus in nonparoxysmal AF patients?
Odds Ratio: 3.611 (95% CI 1.377–9.465)
Absolute Event Rate: 46.3% vs 80.8%
p-value: p=0.002
Combined vein of Marshall ethanol infusion and radiofrequency ablation significantly improves chronic mitral isthmus block durability compared to radiofrequency ablation alone in non-paroxysmal AF.
EIVOM was associated with lower mitral isthmus conduction recovery; supports durability hypothesis but leaves open impact on long-term arrhythmia recurrence.
Background: While combined vein of Marshall ethanol infusion (EIVOM) and radiofrequency ablation improves acute left pulmonary vein (LPV) isolation and posterior mitral isthmus block in nonparoxysmal AF (non-PAF) ablation, its long-term efficacy remains unclear. This multicentre cohort study aimed to evaluate the chronic effect of EIVOM on LPV and mitral isthmus conduction recovery beyond 3 months post-initial ablation. Methods: We retrospectively analysed consecutive non-PAF patients undergoing reablation across three tertiary centres, categorised by EIVOM use during initial ablation: the EIVOM cohort (n=41) versus the non-EIVOM cohort (n=50). Primary endpoints included the prevalence and anatomical distribution of conduction gaps at the LPV antrum and posterior mitral isthmus lines. Results: LPV reconnection rates were comparable (39% in the EIVOM cohort versus 28% in non-EIVOM cohort; p=0.27), with the EIVOM cohort showing more frequent conduction gaps at the inferior antrum of the LPV. Mitral isthmus conduction recovery was significantly reduced in the EIVOM cohort versus the non-EIVOM cohort (46.3% versus 80.8%; p=0.002). Absence of EIVOM use (OR 3.611; 95% CI [1.377-9.465]; p=0.009) and AF duration (OR 1.012; 95% CI [1.002-1.023]; p=0.021) were significant predictors for mitral isthmus conduction recovery. Mitral isthmus conduction gaps were commonly localised at the lateral ridge in both cohorts; endocardial mitral annulus conduction gaps were more frequent in the EIVOM cohort and epicardial vein of Marshall-related epicardial conduction gaps were predominant in the non-EIVOM cohort. Conclusion: The combined EIVOM-radiofrequency ablation strategy significantly improved chronic mitral isthmus block durability but did not enhance long-term durability of LPV isolation compared with radiofrequency ablation alone. Distinct anatomical patterns of LPV and mitral isthmus conduction recovery provide useful clues for refining ablation strategies in non-PAF ablation.
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Kong et al. (2025) conducted a cohort in Nonparoxysmal atrial fibrillation (non-PAF) (n=91). Vein of Marshall ethanol infusion (EIVOM) vs. Radiofrequency ablation alone (non-EIVOM) was evaluated on Mitral isthmus conduction recovery (OR 3.611, 95% CI 1.377-9.465, p=0.002). Vein of Marshall ethanol infusion during initial ablation significantly reduced chronic mitral isthmus conduction recovery compared to radiofrequency ablation alone (46.3% vs 80.8%; p=0.002).
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