Feasibility, efficacy, and safety of ethanol infusion into the vein of Marshall for atrial fibrillation: A meta‐analysis

Abstract Background Contemporary radiofrequency catheter ablation (RFCA) approaches for atrial fibrillation (AF) have reached an efficacy “ceiling”. Ethanol infusion into the vein of Marshall (EI‐VOM) has shown potential in preliminary studies. Data on EI‐VOM are largely limited to small single‐center reports, and clinical benefits and risks have not been systematically examined. Therefore, we performed a meta‐analysis to assess the feasibility, efficacy, and safety of EI‐VOM for AF. Methods All studies evaluating EI‐VOM for AF were initially searched from four electronic search engines: PubMed, Web of Science, Cochrane Library, and SinoMed. We used RevMan5.4 to calculate pooled outcomes of randomized controlled trial and cohort studies. We also performed single‐arm meta‐analyses using Open Meta‐Analyst . Results We included a total of 10 studies with 1322 patients. Successful EI‐VOM was performed in 86.7% (95% CI 81.9–91.4%) of patients. For persistent AF patients, the recurrence of AF and/or atrial tachycardia (AT) was significantly lower in the EI‐VOM combined with RFCA group compared with RFCA alone group (RR 0.58, 95% CI 0.35 to 0.96, p = 0.04). EI‐VOM combined with RFCA significantly increased the rate of bidirectional mitral isthmus block compared with RFCA alone in AF patients (RR 1.50, 95% CI 1.34 to 1.67, p < 0.001). There were nine cardiac tamponades observed in 644 patients (PR 0.8%, 95% CI 0.1–1.5%) who were performed EI‐VOM combined with RFCA. Conclusions Our meta‐analysis brings encouraging evidence that adjuvant EI‐VOM reduces AF and/or AT recurrence rate in persistent AF patients and increases the success rate of bidirectional mitral isthmus block.