Feasibility and efficacy of ethanol infusion into vein of marshall for atrial fibrillation in korean patients

Abstract Background It has been demonstrated that ethanol infusion into vein of Marshall (VOM) during radiofrequency ablation (RFCA) for atrial fibrillation (AF) was feasible and efficient. However, all studies were performed in western countries. We evaluated feasibility, efficacy and safety of ethanol infusion into VOM in AF patients in Korean population. Methods This study was a single center, retrospective study and 132 patients who underwent RFCA with concomitant ethanol infusion trial into VOM from September 2019 to October 2022 were analyzed. Results The mean age was 61.0 [56.0;67.5] years, mean AF duration was 34.8±33.7 months and 105 (79.5%) patients had persistent AF. Successful VOM ethanol infusion was performed in 83 patients (62.9%), while procedure failure was due to nonvisualization of VOM in 16 patients (12.1%) or failure to cannulate VOM in 33 patients (25%). During median 44.0 [21.6;64.5] months of follow-up, atrial tachycardia or atrial fibrillation recurred in 34 patients (36.8%) of 83 patients who underwent successful VOM ethanol infusion. When compared with 1:2 propensity-score matched cohort of patients who had done RFCA for AF alone, VOM ethanol infusion was associated with significantly lower recurrence rate in 2 years (30 [36.1%] in VOM ethanol group vs 84 [50.6%], p=0.044 by log-rank test) (Figure 1). Total 5 (3.7%) acute complications occurred, including 3 subacute pericardial effusion without requiring pericardiocentesis and 2 coronary sinus dissection which did not accompany pericardial effusion or further intervention. Conclusion In Korean population, the rate of nonvisualization or cannulation failure was relatively high and ethanol infusion into vein of Marshall reduced recurrence of atrial tachyarrythmia at 2 year in patients who had underwent RFCA for AF.