Acute Pericardial Effusion After Vein of Marshall Ethanol Infusion for Persistent Atrial Fibrillation

Vein of Marshall ethanol infusion (VOM-EI) is associated with a higher incidence of pericardial effusion (PE). However, few studies have provided detailed explorations of acute PE following VOM-EI. This study aims to identify the risk factors for acute PE following VOM-EI in patients with persistent atrial fibrillation (PeAF).

We conducted a retrospective analysis of 87 patients who underwent VOM-EI and catheter ablation. All patients underwent PE screening with ultrasound within 12 h post-procedure. Left atrial high-density bipolar voltage mapping was performed before and after VOM-EI to identify the VOM-EI related low-voltage area (LVA). The Boruta algorithm and logistic regression were employed to identify risk factors for PE. The model's performance was assessed using the area under the receiver operating characteristic curve (AUC). Acute post-procedural PE was observed in 22 out of 87 patients (25.2%); no cases of cardiac tamponade occurred. The mean effusion depth was 4.59 ± 2.72 mm. The Boruta algorithm ranked the importance of variables as follows: LVA, procedure time, and heart failure. Multiple logistic regression analysis identified LVA as an independent predictor for PE (OR: 1.15; 95% CI: 1.01-1.30; p = 0.030) after adjusting for procedure time and heart failure. The predictive model for LVA exhibited an AUC of 0.681 (95% CI: 0.538-0.824).

Acute PE is a common finding after combined VOM-EI and catheter ablation for PeAF. The VOM-EI-related LVA was identified as an independent risk factor for PE.