{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T01:12:11Z","timestamp":1783127531462,"version":"3.54.6"},"reference-count":62,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"vor","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Pulmonary vein isolation (PVI) alone achieves modest arrhythmia freedom in persistent atrial fibrillation (PeAF). Ethanol infusion of the vein of Marshall (EIVOM) overcomes heat-sink effects, facilitating mitral isthmus (MI) block, and may represent an effective adjunctive ablation strategy. We aimed to quantify the efficacy and safety of EIVOM through a meta-analysis of randomized controlled trials (RCTs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Systematic review of MEDLINE, Web of Science, and PubMed identified 5 RCTs enrolling 1179 patients (602 EIVOM, 577 control). The primary endpoint was 12-month freedom from any atrial arrhythmia. Random-effects models generated risk ratios (RRs) with 95% confidence intervals (CI). Time-to-event data were pooled using a generic inverse-variance approach to derive hazard ratios (HR). EIVOM-based strategies improved freedom from any arrhythmia (RR 1.16, 95% CI 1.04\u20131.29; P &amp;lt; 0.001; number needed to treat (NNT) = 10) and from atrial fibrillation (RR 1.11, 95% CI 1.05\u20131.18; P &amp;lt; 0.001; NNT = 13). Time-to-event analysis demonstrated a sustained reduction in recurrence hazard (HR 0.72, 95% CI 0.64\u20130.81; P = 0.003; I2 = 0%). Repeat ablation was reduced (RR 0.61; P = 0.009). Fluoroscopy time increased (+9.08\u2005min; P = 0.007), while major complications were comparable (2.5% vs. 2.8%; P = 0.47). Trial sequential analysis confirmed that the cumulative Z-curve crossed the monitoring boundary for benefit for the primary endpoint, indicating that the available evidence is sufficient.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In PeAF, EIVOM-based ablation strategies significantly improve 12-month arrhythmia-free survival and reduce repeat procedures without increasing major adverse events. However, the observed benefit reflects composite ablation sets rather than ethanol infusion in isolation, and the predominance of high-volume expert centres may limit generalizability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/europace\/euag069","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T11:43:42Z","timestamp":1775043822000},"source":"Crossref","is-referenced-by-count":2,"title":["Ethanol infusion of the vein of marshall-based strategies for persistent atrial fibrillation: a systematic review and meta-analysis of randomized trials"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5197-9728","authenticated-orcid":false,"given":"Harroop","family":"Bola","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Imperial College London , South Kensington Campus London, London SW7 2AZ ,","place":["UK"]},{"name":"London Northwest Healthcare NHS Trust , Department of Integrated Medicine, Northwick Park Hospital, London HA1 3UJ ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8978-8511","authenticated-orcid":false,"given":"Thalia","family":"Melamed","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Imperial College London , South Kensington Campus London, London SW7 2AZ ,","place":["UK"]},{"name":"London Northwest Healthcare NHS Trust , Department of Integrated Medicine, Northwick Park Hospital, London HA1 3UJ ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3565-1853","authenticated-orcid":false,"given":"Mohamed","family":"Allaf","sequence":"additional","affiliation":[{"name":"Chelsea and Westminster Hospital NHS Foundation Trust , Department of Internal Medicine, London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1073-5825","authenticated-orcid":false,"given":"Joshua J","family":"Hon","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Imperial College London , South Kensington Campus London, London SW7 2AZ ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2610-1666","authenticated-orcid":false,"given":"Gayathri","family":"Giritharan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Imperial College London , South Kensington Campus London, London SW7 2AZ ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9176-2638","authenticated-orcid":false,"given":"Amar","family":"Rai","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Imperial College London , South Kensington Campus London, London SW7 2AZ ,","place":["UK"]},{"name":"Department of Internal Medicine, University of Pennsylvania , Philadelphia, PA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiran Haresh Kumar","family":"Patel","sequence":"additional","affiliation":[{"name":"London Northwest Healthcare NHS Trust , Department of Integrated Medicine, Northwick Park Hospital, London HA1 3UJ ,","place":["UK"]},{"name":"National Heart and Lung Institute, Imperial College London , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8681-4368","authenticated-orcid":false,"given":"Fu Siong","family":"Ng","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Imperial College London , South Kensington Campus London, London SW7 2AZ ,","place":["UK"]},{"name":"Chelsea and Westminster Hospital NHS Foundation Trust , Department of Internal Medicine, London ,","place":["UK"]},{"name":"National Heart and Lung Institute, 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