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Meta-Analysis
. 2024 Jan;47(1):e24178.
doi: 10.1002/clc.24178. Epub 2023 Nov 6.

Efficacy and feasibility of vein of Marshall ethanol infusion during persistent atrial fibrillation ablation: A systematic review and meta-analysis

Wei-Li Ge  1   2 , Tao Li  2 , Yi-Fei Lu  2 , Jian-Jun Jiang  2 , Tao-Hsin Tung  3   4   5 , Su-Hua Yan  1   6
Affiliations
Meta-Analysis

Efficacy and feasibility of vein of Marshall ethanol infusion during persistent atrial fibrillation ablation: A systematic review and meta-analysis

Wei-Li Ge et al. Clin Cardiol. 2024 Jan.

Abstract

Background: Catheter ablation (CA) is currently used to treat persistent atrial fibrillation (PeAF). However, its effectiveness is limited. This study aimed to estimate the effectiveness of the vein of Marshall absolute ethanol injection (VOM-EI) for PeAF ablation.

Hypothesis: Adjunctive vein of Marshall ethanol injection (VOM-EI) strategies are more effective than conventional catheter ablation (CA) and have similar safety outcomes.

Methods: We extensively searched the literature for studies evaluating the effectiveness and safety of VOM-EI + CA compared with CA alone. The primary endpoint was the rate of acute bidirectional block of the isthmus of the mitral annulus (MIBB). The secondary endpoints were atrial fibrillation (AF) or atrial tachycardia (AT) recurrence over 30 seconds after a 3-month blanking period. Weighted pooled risk ratios (RRs) and corresponding 95% confidence intervals (CIs) were calculated using a random effects model.

Results: Based on the selection criteria, nine studies were included in this systematic review, including patients with AF (n = 2508), persistent AF (n = 1829), perimitral flutter (n = 103), and perimitral AT (n = 165). There were 1028 patients in the VOM-EI + CA group and 1605 in the CA alone group. The VOM-EI + CA group showed a lower rate of AF/AT relapse (RR = 0.70; 95% CI = 0.53-0.91; p = .008) and a higher rate of acute MIBB (RR = 1.29; 95% CI = 1.11-1.50; p = .0007) than the CA alone group.

Conclusion: Our meta-analysis revealed that adjunctive VOM-EI strategies are more effective than conventional CA and have similar safety outcomes.

Keywords: ablation; atrial fibrillation; atrial tachycardia; ethanol infusion; vein of Marshall.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta‐Analyses flow diagram for the selection of studies.
Figure 2
Figure 2
Pooled effect sized of VOM‐EI for mitral isthmus ablation. CA, catheter ablation; CI, confidence interval; VOM‐EI + CA, vein of Marshall absolute ethanol injection with catheter ablation.
Figure 3
Figure 3
The overall pooled effect of VOM‐EI on recurrence of atrial arrhythmias. CA, catheter ablation; CI, confidence interval; M‐H, Mantel–Haenszel; VOM‐EI + CA, vein of Marshall absolute ethanol injection with catheter ablation.
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