{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T18:50:23Z","timestamp":1787770223091,"version":"build-2784847793"},"reference-count":23,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,4,5]],"date-time":"2026-04-05T00:00:00Z","timestamp":1775347200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,5]],"date-time":"2026-04-05T00:00:00Z","timestamp":1775347200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pulmonary vein isolation (PVI) remains the primary ablation strategy for atrial fibrillation (AF). However, additional interventions are often required in patients with persistent AF. Ethanol infusion into the vein of Marshall (EIVOM) offers access to epicardial arrhythmic circuits, which has demonstrated incremental benefit in patients with persistent AF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This study aimed to evaluate whether adding VOM ethanol infusion and mitral isthmus ablation to PVI with posterior wall debulking improves long\u2010term arrhythmia outcomes in patients with persistent AF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A total of 123 patients with persistent AF undergoing catheter ablation between June 2021 and December 2023 were retrospectively analyzed. Patients were assigned to PVI\u2009+\u2009posterior wall debulking (PWD) (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200985) or PVI\u2009+\u2009PWD\u2009+\u2009VOM ethanol infusion\u2009+\u2009mitral isthmus ablation (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200938). Demographic, clinical, echocardiographic, and laboratory data were compared. Recurrence of atrial tachyarrhythmia was assessed using Kaplan\u2013Meier survival analysis, and predictors of recurrence were evaluated with Cox proportional hazards models.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During a median follow\u2010up of 12\u201315 months, long\u2010term arrhythmia recurrence occurred in 12.9% of patients treated with PVI\u2009+\u2009PWD and 7.9% of those receiving the additional VOM and mitral isthmus ablation extended approach (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.546). The unadjusted model showed a nonsignificant trend toward reduced recurrence with VOM ethanol infusion (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.45\u20131.22), which remained similar after multivariate adjustment (HR 0.80, 95% CI 0.52\u20131.18).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although adjunctive VOM ethanol infusion and mitral isthmus ablation resulted in a lower observed recurrence rate, no statistically significant improvement in long\u2010term rhythm outcomes was observed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jce.70332","type":"journal-article","created":{"date-parts":[[2026,4,5]],"date-time":"2026-04-05T14:25:23Z","timestamp":1775399123000},"page":"1189-1198","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Comprehensive Substrate Modification in Persistent AF: PVI Plus Posterior Wall Isolation With and Without Vein of Marshall Ethanol Infusion and Mitral Isthmus Ablation"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8555-988X","authenticated-orcid":false,"given":"Tu\u011fba","family":"\u00c7etin","sequence":"first","affiliation":[{"name":"Department of Cardiology Tekirda\u011f \u00c7orlu State Hospital  Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4881-369X","authenticated-orcid":false,"given":"\u015eeyda","family":"Dereli","sequence":"additional","affiliation":[{"name":"Department of Cardiology Dr. Siyami Ersek Thoracic and Cardiovascular Traning and Research Hospital  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