The Long-Term Outcomes of Ablation With Vein of Marshall Ethanol Infusion vs. Ablation Alone in Patients With Atrial Fibrillation: A Meta-Analysis

Abstract

BackgroundThe long-term outcomes of ablation with vein of Marshall ethanol infusion (VOM-ABL) compared with ablation alone in patients with atrial fibrillation (AF) remains elusive. We aimed to explore whether VOM-ABL showed better long-term benefits and screen the potential determinants of outcome impact of VOM-ABL procedure.MethodsPubMed, Cochrane Library, Web of Science, and Embase were searched up to 1st September 2021. Studies comparing the long-term (one-year or longer) outcomes between VOM-ABL and ablation alone were included. Subgroup analysis identified potential determinants for VOM-ABL procedure.ResultsCompared with ablation alone, VOM-ABL was associated with a significantly higher rate of long-term freedom from AF/AT (risk ratio [RR], 1.28; 95% confidence interval [CI], 1.12–1.47; p = 0.00) and successful mitral isthmus (MI) block (RR, 1.52; 95% CI, 1.16–1.99; p = 0.00), whereas, there was no significant difference in pericardial effusion, stroke/transient ischemic attack (TIA), and all-cause death. Subgroup analysis identified two significant treatment-covariate interactions: one was ablation strategy subgroup (pulmonary vein isolation plus linear and/or substrate ablation [PVI+]; RR, 1.41; 95% CI, 1.27–1.56 vs. PVI; RR, 1.05; 95% CI, 0.92–1.19, p = 0.00 for interaction) for freedom from AF/AT, while the other was VOM-ABL group sample size subgroup (≥ 100; RR, 1.98; 95% CI, 1.24–3.17 vs. <100; RR, 1.20; 95% CI, 1.10–1.30, p = 0.04 for interaction) for MI block.ConclusionsThis meta-analysis demonstrates that VOM-ABL has superior efficacy and comparable safety over ablation alone in AF patients with long-term follow-up. Moreover, PVI+ and VOM-ABL group sample size ≥ 100 may be associated with a great impact on freedom from AF/AT and MI block, respectively.

Effects of rhythm control on left atrial structure remodeling in atrial fibrillation and heart failure with preserved ejection fraction

“…The combination of CA and LAAC has been proven beneficial to the long-term prognosis of patients with AF. A meta-analysis demonstrated that ablation with the vein of Marshall ethanol infusion (VOM-ABL) was associated with higher rates of successful mitral isthmus (MI) block and long-term freedom from AF/AT and was comparable safety compared with ablation alone in patients with AF followed over 1 year or more ( 38 ). Moreover, a significant proportion of patients cannot receive CA treatment due to various reasons (old age, over-dilated LA, multiple comorbidities, and worse cardiac functions) in clinical practice.…”

Atrial tachycardia occurring after a prior atrial fibrillation ablation procedure: Does non-inducibility matter?

“…Furthermore, a randomized study demonstrated reduced rates of recurrent AT (and AF) on follow-up in those receiving adjunct VoM ethanol infusion during ablation for persistent AF (41), with peri-mitral block identified as a significant determinant of outcome (42). A recently published meta-analysis of the technique confirmed these findings with greater freedom from recurrent AT and AF with adjunct VoM ethanol infusion compared with ablation alone in patients with AF (43). Epicardial connections across roof lines utilizing the septopulmonary bundle, which again may be insulated by fat, have been demonstrated to be a common cause of failure to achieve roof line block (44).…”

Higher glucose fluctuation is associated with a higher risk of cardiovascular disease: Insights from pooled results among patients with diabetes

“…A subgroup analysis was also performed according to our previous reported methods 13 . A total of seven confounding factors were screened, including study region (Asian and non‐Asian), numbers of patients with diabetes (≥10 000 and < 10 000), age (≥60 years and < 60 years), gender (≥50% male and <50% male), types of diabetes (type 2 diabetes and type 1 diabetes), adjustment of diabetes duration (Yes and No), adjustment of baseline HbA1c (Yes and No), and follow‐up time (≥5 years and <5 years).…”