International Survey on Vein of Marshall Retrograde Ethanol Infusion
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Retrograde ethanolization of the vein of Marshall (VOM) has been identified as an adjunct technique in the treatment of persistent atrial fibrillation (AF) and left atrial tachycardia, as stated in the last consensus statement on ablation of AF. However, there is a lack of high-volume data on the technique. METHODS: Through the collection of data from worldwide centers, we performed this international survey that aims to analyze the safety and procedural characteristics of VOM ethanolization in patients referred for treatment of AF or left atrial tachycardia. RESULTS: We included 5579 patients (66 years; range, 20-93) from 26 centers, who underwent VOM ethanolization between 2008 and 2024 for persistent AF (81%), paroxysmal AF (9%), or left atrial tachycardia (10%) under deep sedation (53%) or general anesthesia (47%). A concomitant mitral isthmus line was attempted in 79% of the cases, achieving mitral isthmus block in 98% of patients. There were 0.92% of periprocedural serious adverse events, including 0.09% of peri-procedural death (5 patients). Three patients developed hemodynamic collapse immediately after VOM ethanolization, causing the death of 1 due to anaphylactic shock. One patient died following surgical drainage of pericardial effusion 3 weeks after the procedure. The 3 other deaths were not directly related to VOM ethanolization. Pericardial effusion was observed in 123 patients (2.2%) at the time of or immediately after the procedure, requiring drainage in 20 patients (0.36%) and later in 32 additional patients (0.57%), including 5 (0.09%) requiring drainage. Pacemaker implantation was required in 2 patients (0.04%), 1 for high-grade atrioventricular block and 1 for sinus node dysfunction. CONCLUSIONS: This international survey shows that VOM ethanolization is predominantly performed in patients with persistent AF. It is associated with rare but potentially life-threatening adverse events. Mitral isthmus line ablation results in a very high rate of block when performed concomitantly.
Authors: Benjamin De Becker, Nicolas Derval, Reshma Amin, Milad El Haddad, Thomas Pambrun, Benjamin Bouyer, Clara Francois, Maarten De Smet, El Mehdi Channan, Nicolas Blankoff, Olaf Krahnefeld, Tolga Agdirlioglu, Damien Minois, Antoine Andorin, Francis Bessiere, Kevin Gardey, Henry W. Sesselberg, Jordan S. Leyton-Mange, Hugo Marchand, Claude Mariottini, Manel Miled, Frédéric A. Sebag, Nicolas Lellouche, Marian Andronache, Procolo Marchese, Andrea Rossi, Martina Nesti, Jean Manuel Herzet, Moisés Rodríguez Manero, Nikola Pavlović, Frédéric Anselme, Corentin Chaumont, Adrianus P. Wijnmaalen, Sebastiaan R.D. Piers, Johan E.P. Waktare, Ali Najm, Alexandre Almorad, Pedro A. Sousa, Caroline Lepièce, Damien Badot, Nathanaël Auquier, Michalis Efremidis, Evgeny Lian, Vera Maslova, René Tavernier, Mattias Duytschaever, Jean Benoit Le Polain de Waroux, Miguel Valderrabano, Sébastien Knecht
Institutions: AZ Sint-Jan, Ziekenhuis aan de Stroom, Centre Hospitalier Universitaire de Bordeaux, Sana Kliniken AG, Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Hospices Civils de Lyon, Hôpital Louis Pradel, Maine Medical Center, Maine Medical Center, Institut Arnault Tzanck, Institute Mutualiste Montsouris, Centre Hospitalier Universitaire Henri-Mondor, Hôpitaux Universitaires Henri-Mondor, Fondazione Toscana Gabriele Monasterio, Centre hospitalier régional de la Citadelle, Complejo Hospitalario Universitario de Santiago, University Hospital Dubrava, Centre Hospitalier Universitaire de Rouen, Leiden University Medical Center, Liverpool Heart and Chest Hospital, Universitair Ziekenhuis Brussel, Unidade Local de Saúde de Coimbra, Onassis Cardiac Surgery Center, University Hospital Schleswig-Holstein, Houston Methodist
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4416905655