Vein of Marshall ethanol infusion improves ablation outcomes in patients with persistent atrial fibrillation

Background

Vein of Marshall ethanol infusion (VoMEI) may improve outcomes among patients with persistent atrial fibrillation (AF) undergoing catheter ablation procedures. Prior investigations used heterogeneous ablation strategies, limiting the understanding of VoMEI utility.

Objective

The study sought to examine the safety and efficacy of a uniform ablation approach utilizing VoMEI compared with patients undergoing pulmonary vein isolation (PVI) only or PVI and posterior wall isolation (PWI).

Methods

Patients undergoing first-time ablation for persistent AF utilizing VoMEI with PVI, PWI, and ablation of induced macro–re-entry arrhythmias were included. Two propensity-matched control groups (PVI only and PVI + PWI) were identified with 2:1 matching. Safety and efficacy rates between the groups were examined.

Results

A total of 155 patients were included (VoMEI, n = 31; PVI, n = 62; PVI + PWI, n = 62), consisting of 98 (63%) males 66 ± 10 years of age, with left atrial diameter 49 ± 7 mm, ejection fraction 50 ± 16%, and follow-up time 3.2 ± 2.2 years, with no demographic differences between the groups (P > .05). The 1-year rate of freedom from atrial arrhythmias after a single procedure was 84%, 67%, and 54% for patients undergoing VoMEI, PVI only, and, PVI + PWI, respectively (log rank P = .021). Patients who underwent VoMEI had improved outcomes compared with patients who did not (hazard ratio 0.32, 95% confidence interval 0.12–0.78, P = .01), with fewer repeat procedures (10% vs 37%, P < .01). Procedure, radiofrequency, and fluoroscopy times were greater in the VoMEI groups (P > .05).

Conclusion

Among patients with persistent AF, an ablation strategy incorporating VoMEI improved long-term ablation outcomes compared with groups of propensity-matched patients undergoing PVI only or PVI + PWI.