ArticleArrhythmia & electrophysiology review2025
Chronic Effects of Vein of Marshall Ethanol Infusion on Pulmonary Vein and Mitral Isthmus Reconnection.
Article in Arrhythmia & electrophysiology review, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: While combined vein of Marshall ethanol infusion (EIVOM) and radiofrequency ablation improves acute left pulmonary vein (LPV) isolation and posterior mitral isthmus block in nonparoxysmal AF (non-PAF) ablation, its long-term efficacy remains unclear. This multicentre cohort study aimed to evaluate the chronic effect of EIVOM on LPV and mitral isthmus conduction recovery beyond 3 months post-initial ablation. Methods: We retrospectively analysed consecutive non-PAF patients undergoing reablation across three tertiary centres, categorised by EIVOM use during initial ablation: the EIVOM cohort (n=41) versus the non-EIVOM cohort (n=50). Primary endpoints included the prevalence and anatomical distribution of conduction gaps at the LPV antrum and posterior mitral isthmus lines. Results: LPV reconnection rates were comparable (39% in the EIVOM cohort versus 28% in non-EIVOM cohort; p=0.27), with the EIVOM cohort showing more frequent conduction gaps at the inferior antrum of the LPV. Mitral isthmus conduction recovery was significantly reduced in the EIVOM cohort versus the non-EIVOM cohort (46.3% versus 80.8%; p=0.002). Absence of EIVOM use (OR 3.611; 95% CI [1.377-9.465]; p=0.009) and AF duration (OR 1.012; 95% CI [1.002-1.023]; p=0.021) were significant predictors for mitral isthmus conduction recovery. Mitral isthmus conduction gaps were commonly localised at the lateral ridge in both cohorts; endocardial mitral annulus conduction gaps were more frequent in the EIVOM cohort and epicardial vein of Marshall-related epicardial conduction gaps were predominant in the non-EIVOM cohort. Conclusion: The combined EIVOM-radiofrequency ablation strategy significantly improved chronic mitral isthmus block durability but did not enhance long-term durability of LPV isolation compared with radiofrequency ablation alone. Distinct anatomical patterns of LPV and mitral isthmus conduction recovery provide useful clues for refining ablation strategies in non-PAF ablation.
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