Can ethanol infusion during ablation improve rhythm maintenance for patients with persistent atrial fibrillation?
For patients with persistent atrial fibrillation (AF), standard catheter ablation (pulmonary vein isolation, or PVI) often has limited success. Adding ethanol infusion into the vein of Marshall (VOM) is an extra step that targets areas resistant to standard ablation. Multiple studies show this combination significantly improves the chance of staying in normal sinus rhythm without needing antiarrhythmic drugs.
What the research says
A meta-analysis of 4 randomized trials (1045 patients) found that adding VOM ethanol infusion to PVI improved sinus rhythm maintenance from 48.6% to 65.8% at 1 year (absolute difference 17.2%) 1. The VENUS trial (350 patients) reported similar benefits, with freedom from AF or atrial tachycardia at 6 and 12 months favoring the ethanol group 5. The PROMPT-AF trial (498 patients) showed that PVI plus VOM ethanol infusion and linear ablation was superior to PVI alone for maintaining sinus rhythm at 12 months 6. A step-by-step guide describes the technique as safe and effective for achieving durable mitral isthmus block 7. Other adjunctive strategies, such as left atrial posterior wall isolation 3 or rotational activity ablation 2, also improve outcomes, but VOM ethanol infusion is a well-studied option. Newer pulsed field ablation catheters show promise 4, but direct comparisons with ethanol infusion are lacking.
What to ask your doctor
- Would adding vein of Marshall ethanol infusion to my ablation procedure be appropriate for my type of persistent AF?
- What is your experience with this technique, and what success rates have you seen in your practice?
- What are the potential risks or side effects of ethanol infusion compared to standard ablation alone?
- How does the recovery and follow-up differ if I receive this additional treatment?
- Are there other adjunctive strategies (like posterior wall isolation) that might be considered instead of or in addition to ethanol infusion?
This question is drawn from common patient questions about Pulmonology & Critical Care and answered using cited medical research. We do not provide individualized advice.