Balancing Arrhythmia Freedom and Complications: A Single Center
Experience with Vein of Marshall Ethanol Infusion as an Adjunct to
Catheter Ablation of Atrial Fibrillation
Abstract
Since the discovery of pulmonary venous triggers,[1](#ref-0001)
catheter ablation with pulmonary vein isolation (PVI) has matured as an
important therapy for patients with atrial fibrillation (AF). However
despite advances in ablation technology, for non-paroxysmal forms of AF,
outcomes remain suboptimal with PVI alone.[](#ref-0002)2
,3 Adjunctive strategies addressing the atrial
substrate or targeting of non-pulmonary vein triggers have not shown
consistent efficacy across studies and may carry additional complication
risks or higher rates of recurrent organized atrial tachycardias.
Recently, ethanol infusion into the vein of Marshall (VOM) has gained
popularity with the publication of the VENUS randomized
trial[4](#ref-0004) and the positive accumulating experience
reported from a single center in Bordeaux.[](#ref-0005)5
,6 However, adoption has been tempered due to the
technical requirements of the procedure and unclear dominant mechanism
of putative benefit. Thus, more widespread experience is needed to
clarify the real-world impact on procedural success. This report aims to
describe a single center experience with VOM ethanol infusion over three
years, with description of technical approach, associated procedural
success rates, and complications.