Saleiro Carolina, Barra Sérgio, Oliveiros Bárbara, Alves Patrícia, Ferreira João, António Natália, Elvas Luís, Gonçalves Lino, Valderrábano Miguel, Sousa Pedro A
Pacing & Electrophysiology Unit, Cardiology Department, Coimbra's Hospital and University Center, Coimbra, Portugal.
Cardiology Department, Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal.
J Cardiovasc Electrophysiol. 2025 Sep 3. doi: 10.1111/jce.70090.
Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation (CA) for atrial fibrillation (AF), yet outcomes remain suboptimal in persistent AF patients. Ethanol infusion in the vein of Marshal (VoM), an embryological remnant implicated in AF pathogenesis, may enhance ablation efficacy.
To evaluate the effectiveness of VoM ethanol infusion in patients with persistent AF.
We conducted a systematic review and meta-analysis of randomized controlled trials (RCT) comparing CA with versus without VoM ethanol infusion in patients undergoing first-time ablation of persistent AF. The primary endpoint was freedom from any atrial arrhythmia in a 12-month follow-up.
Four RCTs including 1045 patients were analyzed (VoM + CA-535 patients vs. CA alone-510 patients). Ethanol infusion in the VoM significantly increased freedom from atrial arrhythmias (RR 1.21; 95% CI 1.010-1.32; p < 0.0001, NNT 10) and reduced the need of a repeat procedure (RR 0.63; 95% CI 0.45-0.87; p = 0.005). Mitral isthmus (MI) block was more frequently achieved in the VoM group (RR 1.30; 95% CI 1.03-1.65; p = 0.03) There was no significant difference in the rate of major complications (2.8% vs. 3.5%, RR 0.72; 95% CI 0.37-1.43; p = 0.35, NNH 138), although overall complications were more frequent in the VoM ethanol infusion group (RR 2.25; 95% CI 1.08-4.70; p = 0.03).
When added to CA, ethanol infusion in the VoM improves freedom from arrhythmia without increasing the risk of major complications. These findings may support its integration into ablation strategies for persistent AF.
肺静脉隔离（PVI）是心房颤动（AF）导管消融（CA）的基石，但持续性AF患者的治疗效果仍不尽人意。在Marshall静脉（VoM）中注入乙醇，该静脉是与AF发病机制相关的胚胎残留结构，可能会提高消融效果。
评估在持续性AF患者中注入VoM乙醇的有效性。
我们对随机对照试验（RCT）进行了系统评价和荟萃分析，比较首次接受持续性AF消融治疗的患者在CA时注入与不注入VoM乙醇的情况。主要终点是12个月随访期间无任何房性心律失常。
分析了4项RCT，共1045例患者（VoM+CA组535例患者 vs. 单纯CA组510例患者）。在VoM中注入乙醇显著提高了无房性心律失常的概率（RR 1.21；95%CI 1.010-1.32；p<0.0001，NNT 10），并减少了重复手术的需求（RR 0.63；95%CI 0.45-0.87；p=0.005）。VoM组更频繁地实现了二尖瓣峡部（MI）阻滞（RR 1.30；95%CI 1.03-1.65；p=0.03）。主要并发症发生率无显著差异（2.8% vs. 3.5%，RR 0.72；95%CI 0.37-1.43；p=0.35，NNH 138），尽管VoM乙醇注入组的总体并发症更常见（RR 2.25；95%CI 1.08-4.70；p=0.03）。
在CA基础上，在VoM中注入乙醇可提高无心律失常的概率，且不增加主要并发症的风险。这些发现可能支持将其纳入持续性AF的消融策略。
