Arrhythmias & electrophysiology
Premature Ventricular Complexes After Atrial Fibrillation Ablation: Impact of Extensive Ablation Strategies and Vein of Marshall Ethanol
Authors' conclusion
EAS-VOMEI was associated with a higher occurrence of PVCs, which more commonly originated from the papillary muscles. EAS-VOMEI may affect ventricular innervation. Future studies are warranted to investigate the ventricular neuromodulatory impact of VOMEI.
Study context
- Population
- Patients after AF ablation with and without EAS with VOMEI (EAS-VOMEI)251 each · EAS-VOMEI 251 · without EAS-VOMEI 251
- Participants
- 502 patients
- Exposure
- AF ablation with vs without EAS-VOMEI
- EAS-VOMEIn = 251
- without EAS-VOMEIn = 251
Methodological detailsacetylcholinesterase staining in human hearts
- Acetylcholinesterase staining in human hearts
Main finding
As reported in the abstract
PVC incidence
EAS-VOMEI
70 of 251
events
Without EAS-VOMEI
15 of 251
events
VOMEIAdjusted hazard ratio (95% CI)P value
Time-to-event analysis over 12 months
4.6(1.5–13.7)
P = 0.005- Higher odds of PVC incidence
- odds (Firth penalized logistic regression) 5.2 (95% CI 2.4–12.1); P < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | EAS-VOMEI | Without EAS-VOMEI |
|---|---|---|
| Papillary muscle PVCs (among patients with PVCs) | 47 of 70 events | 5 of 15 events |
| Bigeminy (among patients with PVCs) | 24 of 70 events | 3 of 15 events |
| Multifocal PVCs (among patients with PVCs) | 33 of 70 events | 6 of 15 events |
| PVC ablation required | 20 events | 7 events |
- Papillary muscle premature ventricular complexes (PVCs) (among patients with PVCs): P < 0.001
- Bigeminy (among patients with PVCs): P < 0.001
- Multifocal PVCs (among patients with PVCs): P < 0.001
- PVC ablation required: P = 0.01
PVC ablation required
- PVC ablation was required in 20 of 70 post-EAS-VOMEI vs 7 of 15 without EAS-VOMEI (P = 0.01)
Innervation (acetylcholinesterase staining)
- Innervation around the vein of Marshall and coronary sinus reached the basal left ventricle
Original publication
Premature Ventricular Complexes After Atrial Fibrillation Ablation: Impact of Extensive Ablation Strategies and Vein of Marshall Ethanol. JACC Clin Electrophysiol. Published 24 March 2026. doi:10.
Summarised from the published abstract; every number is checked against it