Long-term clinical efficacy of Marshall vein ethanol infusion combined with catheter ablation for persistent AF

Recurrent atrial arrhythmia after radiofrequency catheter ablation (RFCA) for persistent atrial fibrillation (AF) necessitates better strategies. Ethanol infusion of the vein of Marshall (EI-VOM) is an emerging adjunct, but long-term efficacy data combined with RFCA is limited. This study compared long-term arrhythmia-free survival between RFCA combined with EI-VOM vs. RFCA alone in persistent AF patients and analyzed outcome predictors.

Persistent AF patients were divided into EI-VOM combined with RFCA (EI-VOM + RFCA, n = 71) and RFCA alone (RFCA, n = 41) groups. Both groups underwent bilateral pulmonary vein isolation and linear ablation. The EI-VOM + RFCA group received ethanol infusion into the vein of Marshall before standard RFCA.

Freedom from atrial arrhythmia recurrence rates in the EI-VOM + RFCA group were significantly higher at all time points: 87.32% at 12 months, 80.25% at 24 months, and 77.46% at 36 months post-procedure. Corresponding rates in the RFCA alone group were lower: 78.05%, 65.85%, and 58.54%. Multivariate analysis identified receiving EI-VOM therapy and a smaller left atrial diameter as independent predictors of maintaining sinus rhythm long-term.

Combining EI-VOM with standard RFCA significantly reduces atrial arrhythmia recurrence compared to RFCA alone in patients with persistent AF, demonstrating superior long-term effectiveness. EI-VOM is an independent predictor of successful sinus rhythm maintenance.