Vein of Marshall ethanol infusion may eliminate atrial fibrillation triggers and facilitate durable mitral isthmus block, though further randomized trials are needed to determine long-term benefits.
Does ethanol infusion into the Vein of Marshall reduce arrhythmia recurrence in patients undergoing persistent AF ablation?
Vein of Marshall ethanol infusion is a promising adjunctive technique to facilitate durable mitral isthmus block and potentially reduce arrhythmia recurrence in persistent AF ablation.
The outcomes of persistent atrial fibrillation (AF) ablation are modest with various adjunctive strategies beyond pulmonary vein isolation (PVI) yielding largely disappointing results in randomised controlled trials. Linear ablation is a commonly employed adjunct strategy but is limited by difficulty in achieving durable bidirectional block, particularly at the mitral isthmus. Epicardial connections play a role in AF initiation and perpetuation. The ligament of Marshall has been implicated as a source of AF triggers and is known to harbour sympathetic and parasympathetic nerve fibres that contribute to AF perpetuation. Ethanol infusion into the Vein of Marshall, a remnant of the superior vena cava and key component of the ligament of Marshall, may eliminate these AF triggers and can facilitate the ease of obtaining durable mitral isthmus block. While early trials have demonstrated the potential of Vein of Marshall 'ethanolisation' to reduce arrhythmia recurrence after persistent AF ablation, further randomised trials are needed to fully determine the potential long-term outcome benefits afforded by this technique.
O’Neill et al. (2024) conducted a review in persistent atrial fibrillation. Vein of Marshall ethanol infusion was evaluated. Vein of Marshall ethanol infusion may eliminate atrial fibrillation triggers and facilitate durable mitral isthmus block, though further randomized trials are needed to determine long-term benefits.