Evidence map›Paper›PMID 41922901›Full record

SynthesisEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2026

Ethanol infusion of the vein of marshall-based strategies for persistent atrial fibrillation: a systematic review and meta-analysis of randomized trials.

Harroop Bola, Thalia Melamed, Mohamed Allaf, Joshua J Hon, Gayathri Giritharan, Amar Rai, Kiran Haresh Kumar Patel, Fu Siong Ng

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Role of interatrial connection ablation in re-entry dynamics: an in silico evaluation.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Harroop BolaFaculty of Medicine, Imperial College London, South Kensington Campus London, London SW7 2AZ, UK.ORCID 0000-0002-5197-9728
Thalia MelamedFaculty of Medicine, Imperial College London, South Kensington Campus London, London SW7 2AZ, UK.ORCID 0009-0009-8978-8511
Mohamed AllafChelsea and Westminster Hospital NHS Foundation Trust, Department of Internal Medicine, London, UK.ORCID 0000-0002-3565-1853
Joshua J HonFaculty of Medicine, Imperial College London, South Kensington Campus London, London SW7 2AZ, UK.ORCID 0009-0004-1073-5825
Gayathri GiritharanFaculty of Medicine, Imperial College London, South Kensington Campus London, London SW7 2AZ, UK.ORCID 0009-0008-2610-1666
Amar RaiFaculty of Medicine, Imperial College London, South Kensington Campus London, London SW7 2AZ, UK.ORCID 0000-0002-9176-2638
Kiran Haresh Kumar PatelLondon Northwest Healthcare NHS Trust, Department of Integrated Medicine, Northwick Park Hospital, London HA1 3UJ, UK.
Fu Siong NgFaculty of Medicine, Imperial College London, South Kensington Campus London, London SW7 2AZ, UK.ORCID 0000-0002-8681-4368

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsPulmonary vein isolation (PVI) alone achieves modest arrhythmia freedom in persistent atrial fibrillation (PeAF). Ethanol infusion of the vein of Marshall (EIVOM) overcomes heat-sink effects, facilitating mitral isthmus (MI) block, and may represent an effective adjunctive ablation strategy. We aimed to quantify the efficacy and safety of EIVOM through a meta-analysis of randomized controlled trials (RCTs). METHODS AND

resultsSystematic review of MEDLINE, Web of Science, and PubMed identified 5 RCTs enrolling 1179 patients (602 EIVOM, 577 control). The primary endpoint was 12-month freedom from any atrial arrhythmia. Random-effects models generated risk ratios (RRs) with 95% confidence intervals (CI). Time-to-event data were pooled using a generic inverse-variance approach to derive hazard ratios (HR). EIVOM-based strategies improved freedom from any arrhythmia (RR 1.16, 95% CI 1.04-1.29; P < 0.001; number needed to treat (NNT) = 10) and from atrial fibrillation (RR 1.11, 95% CI 1.05-1.18; P < 0.001; NNT = 13). Time-to-event analysis demonstrated a sustained reduction in recurrence hazard (HR 0.72, 95% CI 0.64-0.81; P = 0.003; I2 = 0%). Repeat ablation was reduced (RR 0.61; P = 0.009). Fluoroscopy time increased (+9.08 min; P = 0.007), while major complications were comparable (2.5% vs. 2.8%; P = 0.47). Trial sequential analysis confirmed that the cumulative Z-curve crossed the monitoring boundary for benefit for the primary endpoint, indicating that the available evidence is sufficient.

conclusionIn PeAF, EIVOM-based ablation strategies significantly improve 12-month arrhythmia-free survival and reduce repeat procedures without increasing major adverse events. However, the observed benefit reflects composite ablation sets rather than ethanol infusion in isolation, and the predominance of high-volume expert centres may limit generalizability.

Indexed as

Ablation TechniquesAtrial FibrillationCatheter AblationEthanolPulmonary VeinsDisease-Free SurvivalHumansInfusions, IntravenousProgression-Free SurvivalRandomized Controlled Trials as TopicRecurrenceRisk FactorsTime FactorsTreatment OutcomeEthanolAtrial fibrillationCatheter ablationEthanol infusionPersistent atrial fibrillationSubstrate modificationVein of Marshall

Identifiers

PMID41922901
PMCPMC13122365

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.