Cardiovascular therapeutics · 2026
A Novel Intracardiac Echocardiography-Guided Approach for Vein of Marshall Ethanol Infusion in Persistent Atrial Fibrillation Ablation.
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Huang Xiang, Li Xiao-Lan, Feng Jin, Zhang Wei, Li Xiao-Mei
Аннотация
BACKGROUND: The vein of Marshall (VOM) ethanol infusion is an adjunctive strategy for persistent atrial fibrillation (AF) ablation, traditionally guided by VOM venography. However, venography does not allow real-time evaluation of ethanol distribution and carries procedural risks. Intracardiac echocardiography (ICE) provides high-resolution visualization for precise guidance but remains understudied clinically. This study was aimed at evaluating the feasibility, efficacy, and safety of a novel ICE-guided VOM ethanol infusion.
METHODS: A retrospective, matched cohort study was conducted including 126 patients (42 ICE-guided, 84 venography-guided) undergoing de novo radiofrequency (RF) catheter ablation for persistent AF. Propensity score matching (1:2) balanced the groups' baseline characteristics. Procedural endpoints included ethanol-induced low-voltage area (LVA), procedural efficiency (procedure duration and radiation exposure), complications, and 12-month AF/atrial tachycardia (AT) recurrence. ICE-guided procedures utilized real-time monitoring of ethanol-induced tissue changes, whereas venography relied on contrast extravasation.
RESULTS: ICE guidance produced significantly larger ethanol-induced LVAs, shorter total procedure times, reduced fluoroscopy times, shorter VOM ethanol infusion times, shorter mitral isthmus (MI) ablation times, and lower radiation exposure (all p < 0.05). Major complications were rare and similar between groups (p = 0.719). At 12 months, freedom from AF/AT recurrence was comparable between groups (log-rank test, p = 0.66).
CONCLUSIONS: ICE-guided VOM ethanol infusion enhances procedural precision, reduces radiation exposure, and achieves more extensive substrate modification compared with venography. Although clinical recurrence rates were similar, ICE improves workflow efficiency and improves safety by avoiding distal VOM cannulation. These findings support ICE as a transformative tool for optimizing VOM ethanol ablation. Limitations include the nonrandomized design and small sample size, which warrant further validation in randomized trials.
METHODS: A retrospective, matched cohort study was conducted including 126 patients (42 ICE-guided, 84 venography-guided) undergoing de novo radiofrequency (RF) catheter ablation for persistent AF. Propensity score matching (1:2) balanced the groups' baseline characteristics. Procedural endpoints included ethanol-induced low-voltage area (LVA), procedural efficiency (procedure duration and radiation exposure), complications, and 12-month AF/atrial tachycardia (AT) recurrence. ICE-guided procedures utilized real-time monitoring of ethanol-induced tissue changes, whereas venography relied on contrast extravasation.
RESULTS: ICE guidance produced significantly larger ethanol-induced LVAs, shorter total procedure times, reduced fluoroscopy times, shorter VOM ethanol infusion times, shorter mitral isthmus (MI) ablation times, and lower radiation exposure (all p < 0.05). Major complications were rare and similar between groups (p = 0.719). At 12 months, freedom from AF/AT recurrence was comparable between groups (log-rank test, p = 0.66).
CONCLUSIONS: ICE-guided VOM ethanol infusion enhances procedural precision, reduces radiation exposure, and achieves more extensive substrate modification compared with venography. Although clinical recurrence rates were similar, ICE improves workflow efficiency and improves safety by avoiding distal VOM cannulation. These findings support ICE as a transformative tool for optimizing VOM ethanol ablation. Limitations include the nonrandomized design and small sample size, which warrant further validation in randomized trials.