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September 12, 2026Journal of Interventional Cardiac Electrophysiology

Vein of Marshall ethanol infusion in persistent atrial fibrillation: Insight from VOMALC-PeAF registry

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Why the study?

Pulmonary vein isolation has limited efficacy in persistent atrial fibrillation, while strategies combining PVI, vein of Marshall ethanol infusion, and anatomical isthmus ablation have shown promising short-term outcomes.

Comparison

VOM-EI + AS vs PVI-only

Design

Retrospective multicenter observational cohort study

Follow-up

Median 22-month

Key result

A first ablation strategy incorporating vein of Marshall ethanol infusion and anatomical linear lesions resulted in 81% freedom from atrial arrhythmias compared to 47% with PVI alone (p<0.001).

Authors

MIMichele IavaroneARAndrea RossiMNMartina Nesti

Discussion

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Overview

Multicenter cohort study demonstrates superior arrhythmia-free survival with vein of Marshall ethanol infusion in persistent atrial fibrillation, indicating clear benefits over isolation alone.

Key Points

  • To assess whether adding vein of Marshall ethanol infusion and anatomical linear ablation to pulmonary vein isolation improves long-term outcomes in persistent atrial fibrillation.
  • Retrospective multicenter observational cohort study evaluating consecutive patients with persistent atrial fibrillation treated with vein of Marshall ethanol infusion plus anatomical ablation (VOM-EI + AS) or pulmonary vein isolation alone (PVI-only).
  • Conducted 2:1 propensity score matching, yielding 151 patients in the VOM-EI + AS group and 75 in the PVI-only group, followed for a median of 22 months (IQR: 9–35 months).
  • Tracked the primary endpoint of freedom from atrial arrhythmias lasting >30 seconds off antiarrhythmic drugs, alongside procedural safety metrics.
  • Freedom from atrial arrhythmias off antiarrhythmic drugs occurred in 81% of patients in the VOM-EI + AS group versus 47% in the PVI-only group (p < 0.001).
  • Achieving bidirectional mitral isthmus block was the strongest independent predictor of arrhythmia-free survival (HR = 0.114; 95% CI: 0.041–0.321; p < 0.001).
  • Long-standing persistent atrial fibrillation independently predicted a higher risk of arrhythmia recurrence (HR = 2.68; 95% CI: 1.240–5.812; p = 0.012).

Study Design

Type

Cohort (n=226)

Multicenter

Yes

PICO

P
Population
226 propensity-matched patients with persistent atrial fibrillation undergoing ablation, followed for a median of 22 months.
E
Exposure / Comparator
Vein of Marshall ethanol infusion (VOM-EI) + anatomical ablation strategy (AS) vs Pulmonary vein isolation (PVI) only
O
Primary Outcome
Freedom from atrial arrhythmias lasting > 30 s off antiarrhythmic drugs, p=<0.001

Main Result

Absolute Event Rate: 81% vs 47%

p-value: p=<0.001

Cite This Study

Iavarone et al. (2026) conducted a cohort in Persistent atrial fibrillation (n=226). Vein of Marshall ethanol infusion (VOM-EI) + anatomical ablation strategy (AS) vs. Pulmonary vein isolation (PVI) only was evaluated on Freedom from atrial arrhythmias lasting > 30 s off antiarrhythmic drugs (p=<0.001). A first ablation strategy incorporating vein of Marshall ethanol infusion and anatomical linear lesions resulted in 81% freedom from atrial arrhythmias compared to 47% with PVI alone (p<0.001).

synapsesocial.com/papers/6aa55608327956e4761fa09chttps://doi.org/10.1007/s10840-026-02433-4
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Ethanol Infusion in the Vein of Marshall Leads to Parasympathetic Denervation of the Human Left Atrium2014 · 111 citations
  2. 2Impact of Vein of Marshall Ethanol Infusion Combined with Anatomical Ablation for the Treatment of Persistent Atrial Fibrillation: A Long-Term Follow-Up Based on Implantable Loop Recorders2023 · 7 citations
  3. 3Pulmonary Vein Isolation With Optimized Linear Ablation vs Pulmonary Vein Isolation Alone for Persistent AF2024 · 108 citations
  4. 4A proposed index of myocardial staining for vein of Marshall ethanol infusion: an Italian single-center experience2024 · 6 citations
  5. 5International Survey on Vein of Marshall Retrograde Ethanol Infusion2025 · 5 citations