Introduction
Since the discovery of pulmonary venous
triggers,1 catheter
ablation with pulmonary vein isolation (PVI) has matured as an important
therapy for patients with atrial fibrillation (AF). However despite
advances in ablation technology, for non-paroxysmal forms of AF,
outcomes remain suboptimal with PVI
alone.2,3Adjunctive strategies addressing the atrial substrate or targeting of
non-pulmonary vein triggers have not shown consistent efficacy across
studies and may carry additional complication risks or higher rates of
recurrent organized atrial tachycardias. Recently, ethanol infusion into
the vein of Marshall (VOM) has gained popularity with the publication of
the VENUS randomized
trial4 and the positive
accumulating experience reported from a single center in
Bordeaux.5,6However, adoption has been tempered due to the technical requirements of
the procedure and unclear dominant mechanism of putative benefit. Thus,
more widespread experience is needed to clarify the real-world impact on
procedural success. This report aims to describe a single center
experience with VOM ethanol infusion over three years, with description
of technical approach, associated procedural success rates, and
complications.