{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T01:15:57Z","timestamp":1782782157798,"version":"3.54.5"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,4,29]],"date-time":"2022-04-29T00:00:00Z","timestamp":1651190400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The long-term outcomes of ablation with vein of Marshall ethanol infusion (VOM-ABL) compared with ablation alone in patients with atrial fibrillation (AF) remains elusive. We aimed to explore whether VOM-ABL showed better long-term benefits and screen the potential determinants of outcome impact of VOM-ABL procedure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>PubMed, Cochrane Library, Web of Science, and Embase were searched up to 1st September 2021. Studies comparing the long-term (one-year or longer) outcomes between VOM-ABL and ablation alone were included. Subgroup analysis identified potential determinants for VOM-ABL procedure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared with ablation alone, VOM-ABL was associated with a significantly higher rate of long-term freedom from AF\/AT (risk ratio [RR], 1.28; 95% confidence interval [CI], 1.12\u20131.47; <jats:italic>p<\/jats:italic> = 0.00) and successful mitral isthmus (MI) block (RR, 1.52; 95% CI, 1.16\u20131.99; <jats:italic>p<\/jats:italic> = 0.00), whereas, there was no significant difference in pericardial effusion, stroke\/transient ischemic attack (TIA), and all-cause death. Subgroup analysis identified two significant treatment-covariate interactions: one was ablation strategy subgroup (pulmonary vein isolation plus linear and\/or substrate ablation [PVI+]; RR, 1.41; 95% CI, 1.27\u20131.56 vs. PVI; RR, 1.05; 95% CI, 0.92\u20131.19, <jats:italic>p<\/jats:italic> = 0.00 for interaction) for freedom from AF\/AT, while the other was VOM-ABL group sample size subgroup (\u2265 100; RR, 1.98; 95% CI, 1.24\u20133.17 vs. &amp;lt;100; RR, 1.20; 95% CI, 1.10\u20131.30, <jats:italic>p<\/jats:italic> = 0.04 for interaction) for MI block.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This meta-analysis demonstrates that VOM-ABL has superior efficacy and comparable safety over ablation alone in AF patients with long-term follow-up. Moreover, PVI+ and VOM-ABL group sample size \u2265 100 may be associated with a great impact on freedom from AF\/AT and MI block, respectively.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2022.871654","type":"journal-article","created":{"date-parts":[[2022,4,29]],"date-time":"2022-04-29T05:41:15Z","timestamp":1651210875000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":26,"title":["The Long-Term Outcomes of Ablation With Vein of Marshall Ethanol Infusion vs. Ablation Alone in Patients With Atrial Fibrillation: A Meta-Analysis"],"prefix":"10.3389","volume":"9","author":[{"given":"Feng","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-Yu","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Da","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Qu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling-Ling","family":"Qian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ru-Xing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,4,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1142","DOI":"10.1016\/j.amjcard.2013.05.063","article-title":"Estimates of current and future incidence and prevalence of atrial fibrillation in the US adult population","volume":"112","author":"Colilla","year":"2013","journal-title":"Am J Cardiol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1038\/s41569-020-00451-x","article-title":"Catheter ablation for atrial fibrillation: current indications and evolving technologies","volume":"18","author":"Parameswaran","year":"2021","journal-title":"Nat Rev Cardiol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1111\/pace.14071","article-title":"The ligament of Marshall and arrhythmias: a review","volume":"44","author":"He","year":"2021","journal-title":"Pacing Clin Electrophysiol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"e008884","DOI":"10.1161\/CIRCEP.120.008884","article-title":"Impact of vein of Marshall ethanol infusion on mitral isthmus block: efficacy and durability","volume":"13","author":"Nakashima","year":"2020","journal-title":"Circ Arrhythm Electrophysiol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1111\/pace.14052","article-title":"Ethanol infusion into the vein of Marshall for recurrent perimitral atrial tachycardia after catheter ablation for persistent atrial fibrillation","volume":"44","author":"Sang","year":"2021","journal-title":"Pacing Clin Electrophysiol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1620","DOI":"10.1001\/jama.2020.16195","article-title":"Effect of catheter ablation with vein of Marshall ethanol infusion vs catheter ablation alone on persistent atrial fibrillation: the VENUS randomized clinical trial","volume":"324","author":"Valderr\u00e1bano","year":"2020","journal-title":"JAMA."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1111\/pace.14263","article-title":"Feasibility, efficacy, and safety of ethanol infusion into the vein of Marshall for atrial fibrillation: a meta-analysis","volume":"44","author":"He","year":"2021","journal-title":"Pacing Clin Electrophysiol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1016\/j.hrthm.2021.01.005","article-title":"Determinants of outcome impact of vein of Marshall ethanol infusion when added to catheter ablation of persistent atrial fibrillation: a secondary analysis of the VENUS randomized clinical trial","volume":"18","author":"Lador","year":"2021","journal-title":"Heart Rhythm."},{"key":"B9","doi-asserted-by":"publisher","first-page":"105918","DOI":"10.1016\/j.ijsu.2021.105918","article-title":"PRISMA 2020 statement: what's new and the importance of reporting guidelines","volume":"88","author":"Sohrabi","year":"2021","journal-title":"Int J Surg."},{"key":"B10","doi-asserted-by":"publisher","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The cochrane collaboration's tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ."},{"key":"B11","doi-asserted-by":"publisher","first-page":"969","DOI":"10.3390\/jcm9040969","article-title":"The influence of preoperative physical activity on postoperative outcomes of knee and hip arthroplasty surgery in the elderly: a systematic review","volume":"9","author":"Vasta","year":"2020","journal-title":"J Clin Med."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1929","DOI":"10.1097\/BRS.0b013e3181b1c99f","article-title":"2009 updated method guidelines for systematic reviews in the Cochrane back review group","volume":"34","author":"Furlan","year":"2009","journal-title":"Spine."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying heterogeneity in a meta-analysis","volume":"21","author":"Higgins","year":"2002","journal-title":"Stat Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1252","DOI":"10.1093\/europace\/euaa137","article-title":"Acute and mid-term outcome of ethanol infusion of vein of Marshall for the treatment of perimitral flutter","volume":"22","author":"Takigawa","year":"2020","journal-title":"Europace."},{"key":"B15","doi-asserted-by":"publisher","first-page":"2253","DOI":"10.4022\/jafib.2253","article-title":"Comparative study of cryoballoon versus radiofrequency for pulmonary vein isolation when combined with vein of Marshall ethanol infusion for paroxysmal atrial fibrillation","volume":"12","author":"Okishige","year":"2020","journal-title":"J Atr Fibrillation."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1215","DOI":"10.1111\/jce.13969","article-title":"Long-term efficacy and safety of adjunctive ethanol infusion into the vein of Marshall during catheter ablation for nonparoxysmal atrial fibrillation","volume":"30","author":"Liu","year":"2019","journal-title":"J Cardiovasc Electrophysiol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1849","DOI":"10.1111\/jce.15108","article-title":"Effectiveness of ethanol infusion into the vein of Marshall combined with a fixed anatomical ablation strategy (the \u201cupgraded 2C3L\u201d approach) for catheter ablation of persistent atrial fibrillation","volume":"32","author":"Lai","year":"2021","journal-title":"J Cardiovasc Electrophysiol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.1001\/jama.2019.0693","article-title":"Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the CABANA randomized clinical Trial","volume":"321","author":"Packer","year":"2019","journal-title":"JAMA."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1059","DOI":"10.1001\/jama.2019.0335","article-title":"Effect of catheter ablation vs antiarrhythmic medication on quality of life in patients with atrial fibrillation: the CAPTAF randomized clinical trial","volume":"321","author":"Blomstr\u00f6m-Lundqvist","year":"2019","journal-title":"JAMA."},{"key":"B20","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1093\/eurheartj\/ehab648","article-title":"2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC","volume":"42","author":"Hindricks","year":"2021","journal-title":"Eur Heart J."},{"key":"B21","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/j.hfc.2015.08.018","article-title":"Catheter ablation of atrial fibrillation","volume":"12","author":"Latchamsetty","year":"2016","journal-title":"Heart Fail Clin."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1812","DOI":"10.1056\/NEJMoa1408288","article-title":"Approaches to catheter ablation for persistent atrial fibrillation","volume":"372","author":"Verma","year":"2015","journal-title":"N Engl J Med."},{"key":"B23","doi-asserted-by":"publisher","first-page":"52","DOI":"10.14797\/ZQME8581","article-title":"Atrial fibrillation ablation using vein of Marshall ethanol infusion","volume":"17","author":"Lador","year":"2021","journal-title":"Methodist Debakey Cardiovasc J."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1552","DOI":"10.1016\/j.hrthm.2009.07.036","article-title":"Ethanol infusion in the vein of Marshall: adjunctive effects during ablation of atrial fibrillation","volume":"6","author":"Valderr\u00e1bano","year":"2009","journal-title":"Heart Rhythm."},{"key":"B25","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1111\/jce.13797","article-title":"MARSHALL bundles elimination, pulmonary veins isolation and lines completion for anatomical ablation of persistent atrial fibrillation: MARSHALL-PLAN case series","volume":"30","author":"Pambrun","year":"2019","journal-title":"J Cardiovasc Electrophysiol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1016\/j.ipej.2021.04.008","article-title":"What are the post-ablation insular residual electrograms in the posterior left pulmonary veins electrically connected to?","volume":"21","author":"Nakamura","year":"2021","journal-title":"Indian Pacing Electrophysiol J."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1766","DOI":"10.1016\/j.jaccas.2020.06.046","article-title":"Coronary arterial vasospasm: a rare complication of vein of Marshall ethanol infusion for atrial fibrillation","volume":"2","author":"Maeda","year":"2020","journal-title":"JACC Case Rep."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1030","DOI":"10.1016\/j.hrthm.2019.01.031","article-title":"Clinical impact of ethanol infusion into the vein of Marshall on the mitral isthmus area evaluated by atrial electrograms recorded inside the coronary sinus","volume":"16","author":"Kawaguchi","year":"2019","journal-title":"Heart Rhythm."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1610","DOI":"10.1111\/jce.15064","article-title":"Efficacy and safety of ethanol infusion into the vein of Marshall for mitral isthmus ablation","volume":"32","author":"Lam","year":"2021","journal-title":"J Cardiovasc Electrophysiol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1016\/j.hrthm.2020.12.023","article-title":"Marshall bundle elimination, pulmonary vein isolation, and line completion for anatomical ablation of persistent atrial fibrillation (Marshall-PLAN): prospective, single-center study","volume":"18","author":"Derval","year":"2021","journal-title":"Heart Rhythm."},{"key":"B31","doi-asserted-by":"publisher","first-page":"f366","DOI":"10.1093\/europace\/eux297","article-title":"Outcomes of persistent and long-standing persistent atrial fibrillation ablation: a systematic review and meta-analysis","volume":"20","author":"Clarnette","year":"2018","journal-title":"Europace."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1798","DOI":"10.1093\/europace\/euv067","article-title":"Prospective randomized comparison between a fixed '2C3L' approach vs. stepwise approach for catheter ablation of persistent atrial fibrillation","volume":"17","author":"Dong","year":"2015","journal-title":"Europace."},{"key":"B33","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1111\/jce.14856","article-title":"Ablation guided by STAR-mapping in addition to pulmonary vein isolation is superior to pulmonary vein isolation alone or in combination with CFAE\/linear ablation for persistent AF","volume":"32","author":"Honarbakhsh","year":"2021","journal-title":"J Cardiovasc Electrophysiol."},{"key":"B34","doi-asserted-by":"publisher","first-page":"2368","DOI":"10.1161\/CIRCULATIONAHA.110.946806","article-title":"Long-term results of catheter ablation in paroxysmal atrial fibrillation: lessons from a 5-year follow-up","volume":"122","author":"Ouyang","year":"2010","journal-title":"Circulation."},{"key":"B35","doi-asserted-by":"publisher","first-page":"e005250","DOI":"10.1161\/CIRCEP.117.005250","article-title":"Ten-year clinical outcome after circumferential pulmonary vein isolation utilizing the hamburg approach in patients with symptomatic drug-refractory paroxysmal atrial fibrillation","volume":"11","author":"Tilz","year":"2018","journal-title":"Circ Arrhythm Electrophysiol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1016\/j.ijcard.2020.05.032","article-title":"The value of extensive catheter linear ablation on persistent atrial fibrillation (the CLEAR-AF study)","volume":"316","author":"Yao","year":"2020","journal-title":"Int J Cardiol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"2235","DOI":"10.1056\/NEJMoa1602014","article-title":"Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation","volume":"374","author":"Kuck","year":"2016","journal-title":"N Engl J Med."},{"key":"B38","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1007\/s00392-017-1171-5","article-title":"Second generation cryoballoon ablation for persistent atrial fibrillation: an updated meta-analysis","volume":"107","author":"Omran","year":"2018","journal-title":"Clin Res Cardiol."},{"key":"B39","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1111\/jce.13372","article-title":"Second-generation cryoballoon ablation for treatment of persistent atrial fibrillation: three-year outcome and predictors of recurrence after a single procedure","volume":"29","author":"Akkaya","year":"2018","journal-title":"J Cardiovasc Electrophysiol."}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2022.871654\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,29]],"date-time":"2022-04-29T05:41:17Z","timestamp":1651210877000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2022.871654\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,29]]},"references-count":39,"alternative-id":["10.3389\/fcvm.2022.871654"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2022.871654","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,29]]},"article-number":"871654"}}