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Vein of Marshall ethanol infusion for persistent atrial fibrillation: feasibility, safety and efficacy
Session:
Sessão de Comunicações Orais 13 – Para além do isolamento das veias pulmonares: estratégias avançadas na ablação da fibrilhação auricular
Speaker:
Mariana Rodrigues Simões
Congress:
CPC 2026
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Mariana Rodrigues Simões; Ana Luísa Silva; Carolina Saleiro; João Ferreira; Patrícia Alves; Nuno Pontes; José Nascimento; Natália António; Pedro A. Sousa; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Arial",sans-serif">Introduction: </span></strong><span style="font-family:"Arial",sans-serif">Despite limited evidence, two-thirds of physicians perform persistent atrial fibrillation (AF) ablation beyond pulmonary veins isolation. Recent trials and meta-analyses have shown that vein of Marshall (VoM) ethanol infusion provides additional benefit, consistent with the findings in the VENUS trial.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Arial",sans-serif">Methods and purpose:</span></strong><span style="font-family:"Arial",sans-serif"> Single-centre, retrospective, observational study of patients referred for first procedure radiofrequency (RF) catheter ablation between</span> <span style="font-family:"Arial",sans-serif">August 2022 and August 2024.<strong><span style="font-family:"Arial",sans-serif"> </span></strong>All redo-procedures were excluded. </span></span><span style="font-family:"Arial",sans-serif">The blanking period for atrial arrhythmia recurrence was 3 months. </span><span style="font-family:"Times New Roman",serif"><span style="font-family:"Arial",sans-serif">We aimed to assess the feasibility, safety, and efficacy of VoM ethanol infusion for persistent AF ablation. </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Arial",sans-serif">Results: </span></strong><span style="font-family:"Arial",sans-serif">A total of 100 patients were included (70% </span><span style="font-family:"Arial",sans-serif">male, mean age of 62±11years)</span><span style="font-family:"Arial",sans-serif">. Vein of Marshall (VoM) ethanol infusion was attempted in 41 patients and was successfully achieved in 35 patients (85%). Infusion was unsuccessful in 6 cases: the VoM could not be identified in 4 patients, cannulation was not possible in 1, and dissection of the vein occurred in another</span><span style="font-family:"Arial",sans-serif">. </span></span></span><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Arial",sans-serif">One complication occurred in the VoM group (a mild-to-moderate pericardial effusion), while an esophagitis was reported in the group that not performed VoM ethanol infusion. Both cases were managed conservatively. </span></span></span><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Arial",sans-serif">At 1-year follow-up, 21 patients experienced recurrence of sustained atrial arrhythmia: 18 with persistent AF, 2 with atrial tachycardia and one with atrial flutter. Overall, single-procedure freedom from atrial arrhythmia was 79%. The risk of recurrence was significantly lower in the VoM group (8.5% vs 28.1%, p=0.030) (Fig. 1)</span><span style="font-size:8.0pt"> </span><span style="font-family:"Arial",sans-serif">. VoM ethanol infusion was associated with freedom from atrial arrhythmia at 1 year follow-up with a HR of 0.28 (95% CI, 0.08-0,96), p=0.021.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Arial",sans-serif">Conclusion: </span></strong><span style="font-family:"Arial",sans-serif">The VoM ethanol infusion seem to be a feasible</span><span style="font-family:"Arial",sans-serif">, safe and effective approach for persistent AF ablation. </span></span></span></p>
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