Efficacy and safety of ethanol infusion into the vein of marshall combined with radiofrequency catheter ablation in patients with persistent atrial fibrillation and heart failure
L Kong, X WangAbstract
Background/Introduction
Atrial fibrillation (AF) and heart failure (HF) exhibit a bidirectional, mutually exacerbating relationship, posing significant clinical challenges. Recent studies suggest that ethanol infusion into the vein of Marshall (EIVOM) combined with radio-frequency catheter ablation (RFCA) may enhance procedural efficacy by facilitating mitral isthmus block[1-3]. However, evidence for this approach in AF patients with concomitant HF remains limited.
Purpose
This study aimed to evaluate the safety and efficacy of combined EIVOM-RFCA versus RFCA alone in patients with persistent AF and HF.
Methods
A retrospective analysis was conducted across four centers on patients with persistent AF, reduced left ventricular ejection fraction (LVEF ≤50%), and undergoing initial catheter ablation. Baseline clinical parameters, intra-procedural technical data, and peri-operative outcomes were analyzed. Primary endpoints included freedom from HF exacerbation and arrhythmia-free survival at 1 year post-procedure. Secondary endpoints comprised mortality, ischemic stroke, and bleeding events.
Results
Among 91 eligible patients (44 in the combined EIVOM-RFCA group; 47 in the RFCA-alone group), the cohort had a median age of 63.5±9.2 years, 75.8% male (69/91), median CHA2DS2-VASc score of 3 (IQR 2–4), and median LVEF of 40% (IQR 35–45). Baseline characteristics were comparable between groups. At 1 year, the combined group demonstrated significantly higher HF-exacerbation-free rates (95.5% [42/44] vs. 76.6% [36/47], P=0.011, Hazard Ratio, 0.185; 95%CI, 0.062-0.548) and higher arrhythmia-free survival (84.1% [37/44] vs. 59.6% [28/47], P=0.013, Hazard Ratio, 0.371; 95%CI, 0.172-0.801). One non-procedure-related death occurred in the RFCA group at 10 months. Bleeding events were comparable (4.5% [2/44] vs. 2.1% [1/47], p=0.52), with no perioperative ischemic strokes. Pericardial effusion rates were 6.8% (3/44) and 4.3% (2/47) in the combined and RFCA-alone groups, respectively (p=0.59), showing no statistically significant difference.
Conclusion
Our study provides robust real-world evidence that a combined EIVOM and RFCA strategy significantly improves both rhythm control and clinical HF outcomes in patients with PeAF and HFrEF. It represents a paradigm shift from simply isolating pulmonary veins to more optimized and individualized strategy in these patients.Freedom from AFduring 1-year follow-upFor image description, please refer to the figure legend and surrounding text.Freedom from HF during 1-year follow-upFor image description, please refer to the figure legend and surrounding text.