Complication after vein of Marshall ethanol ablation: A case of acute cardiogenic shock and death

Vein of Marshall (VOM) ethanol infusion has emerged as an effective adjunctive therapy for atrial tachyarrhythmias, particularly in patients with persistent atrial fibrillation (AF). Due to its insulation by surrounding fat, radiofrequency ablation of the VOM bundle has long been challenging. Chemical ablation via retrograde ethanol infusion offers a more efficient approach, improving arrhythmia suppression1. Recent multicenter trial data suggest that VOM ethanol infusion, beyond pulmonary vein isolation, reduces the recurrence of atrial tachyarrhythmias in persistent AF 2.