Arrhythmias & electrophysiologyCohort study
The impact of vein of Marshall alcohol or radiofrequency ablation in patients with persistent atrial fibrillation undergoing catheter ablation in the REAL-AF registry
- multicenter, prospective, observational registry
Authors' conclusion
VoM EtOH ablation for PsAF seems safe and efficacious as an adjunctive strategy for the treatment of PsAF. Findings are not based on cohort size, but on comparative effectiveness and safety across distinct ablation strategies in real-world practice.
Study context
- Population
- Patients with persistent atrial fibrillation (PsAF) undergoing de novo radiofrequency ablation, January 2018 to August 2024patients with PsAF treated with radiofrequency ablation (RFA)
- Participants
- 746 patients
- Exposure
- Pulmonary vein isolation (PVI) only vs PVI + substrate modification (SM) + vein of Marshall (VoM) RFA vs PVI + SM + VoM EtOH
- group 1n = 564
- group 2n = 94
- group 3n = 88
Main finding
As reported in the abstract
Scar burden
Observational data: associations, not effects.
Further findings
Procedure time
Arrhythmia recurrence · through 12 months
Repeat ablations · through 12 months
- Arrhythmia recurrence: P = .023
- Repeat ablations: P = .654
Safety
| Outcome | group 1 | group 2 | group 3 |
|---|---|---|---|
| Acute complication rates | Not reported in the abstract | Not reported in the abstract | 0% |
| Complication rates · 12-month | Not reported in the abstract | Not reported in the abstract | 2.3% |
- Acute complication rates: P = .438
- Complication rates: P = .896
Acute complication rates
- Acute complication rates were low in all groups, lowest in group 3
Original publication
The impact of vein of Marshall alcohol or radiofrequency ablation in patients with persistent atrial fibrillation undergoing catheter ablation in the REAL-AF registry. Heart Rhythm. Published 6 March 2026. doi:10.1016/j.hrthm.2026.02.049
Summarised from the published abstract; every number is checked against it