{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T09:38:22Z","timestamp":1777628302559,"version":"3.51.4"},"reference-count":25,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"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":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Catheter ablation for persistent atrial fibrillation (AF) exhibits suboptimal outcomes after pulmonary vein isolation (PVI) alone. The vein of Marshall (VOM) has emerged as an adjunctive ablation target, through which ethanol infusion can achieve transmural lesions in regions resistant to radiofrequency ablation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the efficacy and safety of adjunctive VOM ethanol infusion in patients undergoing catheter ablation for persistent AF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a meta\u2010analysis of randomized controlled trials (RCTs) comparing PVI \u00b1 linear ablation with versus without VOM ethanol infusion for persistent AF. The primary outcome was freedom from AF recurrence, analyzed using odds ratios and hazard ratios for time\u2010to\u2010event data. Secondary outcomes included procedural metrics and complications. Data were pooled using random\u2010effects models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Four RCTs (\n                      <jats:italic>n<\/jats:italic>\n                      = 1045 patients) were included. VOM ethanol infusion significantly improved sinus rhythm maintenance (65.8%\u00a0vs. 48.6%; absolute difference 17.2%; OR: 1.68, 95% CI: 1.13\u20132.49,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.025). Time\u2010to\u2010event analysis showed consistent benefit of maintaining sinus rhythm during the first post\u2010procedure year (pooled HR: 0.73, 95% CI: 0.59\u20130.91,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.005) with high mitral isthmus block rates (90%). Subgroup analysis showed consistent sinus rhythm maintenance whether ethanol was added to PVI alone (OR: 1.66) or PVI with linear ablation (OR: 1.69). Fluoroscopy time was longer (+10.3\u00a0min,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0009) with VOM ethanol infusion. Complication rates were similar (OR: 1.55,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.46).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Adjunctive VOM ethanol infusion significantly improves ablation outcomes in persistent AF without increasing major complications. It represents a promising strategy to enhance durable rhythm control. Further research is required to evaluate long\u2010term outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pace.70175","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T16:01:44Z","timestamp":1771603304000},"page":"581-589","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy of Vein of Marshall Ethanol Infusion in Persistent Atrial Fibrillation Ablation: A Meta\u2010Analysis of RCTs"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2965-8709","authenticated-orcid":false,"given":"James","family":"Zhang","sequence":"first","affiliation":[{"name":"Essex Cardiothoracic Centre  Basildon UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil","family":"Srinivasan","sequence":"additional","affiliation":[{"name":"Essex Cardiothoracic Centre  Basildon UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4939-7577","authenticated-orcid":false,"given":"Achi","family":"Kamaraj","sequence":"additional","affiliation":[{"name":"Royal Brisbane Hospital  Brisbane Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Smrithi","family":"Pushpakaran","sequence":"additional","affiliation":[{"name":"Clinical School of Medicine Cambridge University  Cambridge UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajdip","family":"Dulai","sequence":"additional","affiliation":[{"name":"Essex Cardiothoracic Centre  Basildon UK"},{"name":"University College London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"StatPearls","author":"Nesheiwat Z.","year":"2025"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2022.02.001"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euaf037"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2020.12.023"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2021.03.032"},{"key":"e_1_2_10_7_1","unstructured":"PRISMA statement. PRISMA statement. Accessed July 8 2025 https:\/\/www.prisma\u2010statement.org."},{"key":"e_1_2_10_8_1","unstructured":"RoB 2: A Revised Cochrane Risk\u2010of\u2010Bias Tool for Randomized Trials | Cochrane Bias. Accessed July 9 2025 https:\/\/methods.cochrane.org\/bias\/resources\/rob\u20102\u2010revised\u2010cochrane\u2010risk\u2010bias\u2010tool\u2010randomized\u2010trials."},{"key":"e_1_2_10_9_1","unstructured":"Posit. Posit. Accessed July 14 2025 https:\/\/www.posit.co\/."},{"key":"e_1_2_10_10_1","unstructured":"Effect of Catheter Ablation With Vein of Marshall Ethanol Infusion vs Catheter Ablation Alone on Persistent Atrial Fibrillation: The VENUS Randomized Clinical Trial\u2014PubMed. Accessed June 20 2025 https:\/\/pubmed.ncbi.nlm.nih.gov\/33107945\/."},{"key":"e_1_2_10_11_1","unstructured":"Marshall\u2010Plan Ablation Strategy Versus Pulmonary Vein Isolation in Persistent AF: A Randomized Controlled Trial\u2014PMC. Accessed June 20 2025 https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC12094258\/."},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2023.11.027"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.24438"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2024.1253554"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.31083\/j.rcm2504112"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13082438"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.15573"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.15593"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/clc.24178"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2022.03.1228"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.14797\/ZQME8581"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.19102\/icrm.2023.14122"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.871654"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2023.1194687"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2021.11.019"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.1031673"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70175","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pace.70175","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70175","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T01:39:37Z","timestamp":1777426777000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.70175"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,20]]},"references-count":25,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1111\/pace.70175"],"URL":"https:\/\/doi.org\/10.1111\/pace.70175","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,20]]},"assertion":[{"value":"2025-10-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}