The following is a summary of “Efficacy and feasibility of vein of Marshall ethanol infusion during persistent atrial fibrillation ablation: A systematic review and meta-analysis,” published in the November 2023 issue of Cardiology by Ge et al.
Catheter ablation (CA) is a treatment for persistent atrial fibrillation(PeAF), but it is not always effective. Researchers performed a retrospective study to analyze the effectiveness of the vein of Marshall absolute ethanol injection (VOM-EI) for PeAF.
The study hypothesized that VOM-EI is more effective than CA for PeAF ablation, with similar safety outcomes. They conducted a comprehensive literature search to assess the effectiveness and safety of VOM-EI + CA compared to CA alone. The primary outcome measure was the rate of acute bidirectional block of the isthmus of the mitral annulus (MIBB). Secondary endpoints included the recurrence of atrial fibrillation (AF) or atrial tachycardia (AT) lasting over 30 seconds after a 3-month blanking period. They also calculated weighted pooled risk RRs with associated 95% CI derived from a random effects model.
The result demonstrated that 9 studies meeting the selection criteria were included, involving patients with AF (n=2,508), persistent AF (n=1,829), perimitral flutter (n=103), and perimitral AT (n=165). The VOM-EI + CA group comprised 1,028 patients, while the CA alone group had 1605 patients. The VOM-EI + CA group exhibited a lower rate of AF/AT relapse (RR=0.70; 95% CI=0.53–0.91; P=0.008) and a higher rate of acute MIBB (RR=1.29; 95% CI=1.11–1.50; P=0.0007) compared to the CA alone group.
The study found that VOM-EI improved PeAF ablation success rates with similar safety to conventional CA.
Source: onlinelibrary.wiley.com/doi/full/10.1002/clc.24178
