Arrhythmias & electrophysiology
International Survey on Vein of Marshall Retrograde Ethanol Infusion
Authors' conclusion
This international survey shows that VOM ethanolization is predominantly performed in patients with persistent AF. It is associated with rare but potentially life-threatening adverse events. Mitral isthmus line ablation results in a very high rate of block when performed concomitantly.
Study context
- Population
- Patients undergoing vein of Marshall (VOM) ethanolization for persistent atrial fibrillation (AF), paroxysmal AF or left atrial tachycardia, 2008–2024
- Participants
- 5,579 patients26 centres
- Outcome
- Safety and procedural characteristics of VOM ethanolization
Methodological detailsinternational survey, multicentre (26 centres)
- International survey
- Multicentre (26 centres)
Main finding
As reported in the abstract
- Indication: persistent AF
- 81%
- Indication: paroxysmal AF
- 9%
- Indication: left atrial tachycardia
- 10%
- Deep sedation
- 53%
- General anaesthesia
- 47%
- Concomitant mitral isthmus line attempted
- 79%
- Mitral isthmus block achieved
- 98%
Observational data: associations, not effects.
Safety
Periprocedural serious adverse events
- Serious adverse events
- 0.92%
- Periprocedural death (5 patients)
- 0.09%
- Hemodynamic collapse immediately after VOM ethanolization (1 death, anaphylactic shock)
- 3
- Death after surgical drainage of pericardial effusion 3 weeks post-procedure
- 1
- Deaths not directly related to VOM ethanolization
- 3
Pericardial effusion
- At time of or immediately after procedure
- 123 (2.2%)
- Early, requiring drainage
- 20 (0.36%)
- Later, additional
- 32 (0.57%)
- Later, requiring drainage
- 5 (0.09%)
Pacemaker implantation
- Pacemaker implantation (1 high-grade AV block, 1 sinus node dysfunction)
- 2 (0.04%)
Original publication
International Survey on Vein of Marshall Retrograde Ethanol Infusion. Circ Arrhythm Electrophysiol. Published 2 December 2025. doi:10.
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