Efficacy and safety of catheter ablation with vein of Marshall ethanol infusion in patients with persistent AF and HFrEF.

Atrial fibrillation (AF) is a common arrhythmia that usually coexists with heart failure (HF). However, research into the efficacy and safety of catheter ablation with vein of Marshall ethanol infusion (VOM-EI) in patients with persistent AF and HF with reduced ejection fraction (HFrEF) is limited. In the present study, a single-center retrospective study was conducted, involving 85 patients with persistent AF and HFrEF. Patients in group A (n=40; male/female: 29/11; average age: 62.33±11.50 years) received catheter ablation plus VOM-EI treatment, while patients in group B (n=45; male/female: 34/11; average age: 59.36±10.91 years) received catheter ablation only. The study compared the two groups regarding primary endpoint events (rate of restoration of sinus rhythm after surgery and rate of postoperative AF recurrence) and secondary endpoint events [cardiac function parameters (left ventricular ejection fraction (LVEF), left atrium diameter (LAD), left ventricular end diastolic volume (LVEDV)], New York Heart Association (NYHA) classification, B-type natriuretic peptide (BNP) and rate of postoperative rehospitalization] at 6 months of follow-up. Surgery duration and perioperative adverse events were also compared between the two groups. There were no statistical differences in baseline characteristics, CHA2DS2-VASc score and HAS-BLED score between the two groups. In comparison with group B, group A had a decreased rate of postoperative AF recurrence (2.78 vs. 21.05%). Compared with preoperative levels, both groups achieved significant enhancement in postoperative LVEF, LVEDV and LAD. Group A exhibited a significantly greater improvement in postoperative LVEF, NYHA classification and BNP levels compared with group B. No significant differences were observed between the two groups in the rate of sinus rhythm restoration (90.0 vs. 84.44%) and the rate of postoperative rehospitalization (2.78 vs. 15.79). In addition, group A exhibited a significantly shorter surgical duration than group B (156.78±39.36 min vs. 181.73±52.39 min). There were no statistically significant differences in the rate of perioperative adverse events between the two groups (7.5 vs. 8.89%). In summary, the use of VOM-EI in conjunction with catheter ablation is a safe and effective strategy for treating patients with persistent AF and HFrEF. This approach results in effective cardiac function restoration, lower postoperative AF recurrence rate, and shorter surgical time.