Ethanol infusion of the vein of Marshall in catheter ablation of persistent atrial fibrillation in patients with mitral valve replacement

Cheng, XH; Liu, XY; Wang, W; Zhao, X; Li, CY; Yu, RH; Liu, N; Li, SN; Liu, XX; Guo, XY; Zuo, S; Li, MM; Liu, T; Huang, LH; Lv, WH; Li, YK; Wang, XS; Li, JL; Du, ZH; Li, XR; Jiang, CX; Sang, CH; Long, DY; Dong, JZ; Ma, CS; Tang, RB

doi:10.1016/j.hrthm.2025.09.001

Arrhythmias & electrophysiology

Ethanol infusion of the vein of Marshall in catheter ablation of persistent atrial fibrillation in patients with mitral valve replacement

Heart RhythmPublished 4 Sep 2025retrospective case-control study

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Authors' conclusion

EIVOM significantly improved the MI linear block rate and the sinus rhythm maintenance rate in patients with persistent AF and MVR.

Study context

Population: Patients with persistent atrial fibrillation (AF) and mitral valve replacement (MVR) who underwent first-time catheter ablation
Participants: 27 vs 33

Comparison: Mitral isthmus (MI) block rate, procedure-related complications, and sinus rhythm maintenance rate were compared between the 2 groups in the intention-to-treat population.
EIVOM groupn = 27
Control groupn = 33
Outcome: MI block rate

Main finding

As reported in the abstract

EIVOM group77.8%

Control group51.5%

P = 0.036

Observational data: associations, not effects.

Further findings

Sinus rhythm maintenance rate · 13.5 months of follow-up (interquartile range, 7.0-22.2) — EIVOM group vs control group

P = 0.032

EIVOM group63.0%

Control group36.4%

Sinus rhythm maintenance rate · 13.5 months of follow-up (interquartile range, 7.0-22.2)

	← Lower ←→ Higher →	Hazard ratio (95% CI)	P value
EIVOM	0.10.31310	0.35 (0.16–0.78)	P = 0.009
	0.10.31310Hazard ratio (log scale)

Sinus rhythm maintenance rate: significantly higher in the EIVOM group than in the control group
Sinus rhythm maintenance rate: multivariate Cox analysis; independently associated with the sinus rhythm maintenance rate

Baseline characteristics

No significant differences in baseline characteristics between the 2 groups

EIVOM procedural success

Patients who successfully underwent EIVOM: Twenty-two

Safety

Outcome	EIVOM group	Control group
Procedure-related complications	self-resolved pericardial effusion	pseudoaneurysm

Original publication

Ethanol infusion of the vein of Marshall in catheter ablation of persistent atrial fibrillation in patients with mitral valve replacement. Heart Rhythm. Published 4 September 2025. doi:10.1016/j.hrthm.2025.09.001

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