Long-term efficacy and safety of adjunctive ethanol infusion into the vein of Marshall during catheter ablation for nonparoxysmal atrial fibrillation

Chih Min Liu, Li Wei Lo, Yenn Jiang Lin, Chin Yu Lin, Shih Lin Chang, Fa Po Chung, Tze Fan Chao, Yu Feng Hu, Ta Chuan Tuan, Jo Nan Liao, Yun Yu Chen, Ling Kuo, Ting Yung Chang, Quang Minh Hoang, Simon Salim, Jennifer Jeanne B. Vicera, Cheng I. Wu, Chieh Mao Chuang, Ting Chung Huang, Shih Ann Chen

Research output: Contribution to journalArticlepeer-review

25 Citations (Scopus)


Introduction: We aimed to clarify the effect of vein of Marshall (VOM) ethanol infusion for treating VOM triggers and/or mitral flutter after first-attempt endocardial ablation in patients with nonparoxysmal atrial fibrillation (AF). Methods and Results: Of the 254 consecutive patients (age, 56 ± 10 years; 221 male) undergoing catheter ablation for drug-refractory nonparoxysmal AF, 32 (12.6%) received VOM ethanol infusion. The patients were stratified into group 1 (pulmonary vein isolation [PVI], substrate modification, VOM ethanol infusion), group 2 (PVI, substrate modification), and group 3 (PVI alone). Propensity-matched analysis (N = 128) of long-term outcomes (3.9 ± 0.5 years) revealed a higher AF recurrence risk in group 2 (hazard ratio [HR], 4.17; 95% confidence interval [95% CI], 1.63-10.69; P =.003) and group 3 (HR, 1.82; 95% CI, 1.09-3.04; P =.021) than in group 1, as well as a higher atrial arrhythmia recurrence risk in group 2 than in group 1 (HR, 2.42; 95% CI, 1.16-5.03; P =.018). A higher procedural termination rate was observed in group 1 than groups 2 and 3 (41.7% vs 17.2% vs 18.8%; P =.042). On multivariate analysis, VOM ethanol injection was an independent predictor of freedom from recurrence of AF (HR, 0.20; 95% CI, 0.08-0.52; P =.001) and atrial arrhythmia (HR, 0.35; 95% CI, 0.17-0.74; P =.005), whereas a left atrial diameter >45 mm and hypertension were independent risk factors for recurrence. Periprocedural complications rates were comparable among the groups. Conclusion: Adjunctive VOM ethanol infusion is effective and safe for treating nonparoxysmal AF in patients with VOM triggers and/or refractory mitral flutter, providing good long-term freedom from AF and atrial arrhythmia.

Original languageEnglish
Pages (from-to)1215-1228
Number of pages14
JournalJournal of Cardiovascular Electrophysiology
Issue number8
Publication statusPublished - 2019

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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