Adding vein of Marshall ethanol infusion to catheter ablation improves AF outcomes: JAMA

USA: The addition of vein of Marshall ethanol infusion to the standard treatment of catheter ablation increases the likelihood of successful treatment for atrial fibrillation as compared to catheter ablation alone, suggests a recent study in the journal JAMA. The findings were also presented at the annual meeting for the American College of Cardiology.

Atrial fibrillation (AF) is irregular and abnormal heart rhythm. If treated AF can lead to blood clots, heart failure and stroke. Catheter ablation, the standard treatment for AF, uses electrical energy for resetting the heartbeat. While the procedure is effective for some patients, in some it needs to be repeated multiple times to get the desired results.

The Vein of Marshall Ethanol for Untreated Persistent Atrial Fibrillation (VENUS) trial by Miguel Valderrábano, Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas, and colleagues aimed to determine whether vein of Marshall ethanol infusion could improve ablation results in persistent AF when added to catheter ablation. 

The trial was an investigator-initiated, National Institutes of Health–funded, randomized, single-blinded trial conducted in 12 centers in the United States. It included 350 patients with persistent AF referred for first ablation. Patients were randomly assigned to receive either catheter ablation alone (n = 158) or catheter ablation combined with vein of Marshall ethanol infusion (n = 185) in a 1:1.15 ratio to accommodate for 15% technical vein of Marshall ethanol infusion failures. The primary outcome was freedom from AF or atrial tachycardia for longer than 30 seconds after a single procedure, without antiarrhythmic drugs, at both 6 and 12 months.