Catheter ablation was found to be associated with greater rates of freedom from atrial fibrillation (AF) or atrial tachycardia in patients with persistent AF, when performed in combination with vein of Marshall ethanol infusion vs alone, according to a study published in JAMA.
In this Vein of Marshall Ethanol for Untreated Persistent AF study (VENUS;
ClinicalTrials.gov Identifier: NCT01898221), a multicenter trial, 350 patients with persistent AF (mean age, 66.5 years) were enrolled. Participants were randomly assigned to receive catheter ablation alone (n=158) or in combination with a vein of Marshall ethanol infusion (n=185).
The study’s primary outcome was freedom from AF or atrial tachycardia for >30 seconds following a single procedure and without antiarrhythmic drugs at 6 and 12 months. Secondary outcomes included AF burden, freedom from AF after multiple procedures, and quality of life.
A greater percentage of patients receiving catheter ablation in combination with vein of Marshall ethanol infusion vs alone were free from AF/atrial tachycardia after a single procedure at 6 and 12 months (49.2% vs 38%, respectively; difference, 11.2%; 95% CI, 0.8%-21.7%; P =.04).
Patients receiving catheter ablation plus vein of Marshall infusion vs catheter ablation alone experienced significant improvements in AF burden (zero burden in 78.3% vs 67.9%, respectively; difference, 10.4%; 95% CI, 2.9%-17.9%; P =.01), freedom from AF after multiple procedures (65.2% vs 53.8% respectively; difference, 11.4%; 95% CI, 0.6%-22.2%; P =.04), and success in achieving perimitral block (80.6% vs 51.3%, respectively; difference, 29.3%; 95% CI, 19.3%-39.3%; P <.001). No differences were found between the 2 groups in terms of adverse events.
Limitations of this study include its single-blinded design as well as the lack of completion of the vein of Marshall ethanol infusion procedure in some participants.
While the combination of vein of Marshall ethanol infusion and catheter ablation appears promising for patients with AF, the investigators concluded that “further research is needed to assess longer-term efficacy.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Valderrábano M, Peterson LE, Swarup V, et al. Effect of catheter ablation with vein of Marshall ethanol infusion vs catheter ablation alone on persistent atrial fibrillation: The VENUS randomized clinical trial. JAMA. 2020;324(16):1620-1628. doi:10.1001/jama.2020.16195