{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T18:11:08Z","timestamp":1793211068660,"version":"4.5.0"},"reference-count":80,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T00:00:00Z","timestamp":1772236800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide and is associated with significant morbidity, mortality, and health care expenditure. Catheter ablation is the most effective treatment strategy to decrease AF burden, a measure strongly correlated with significant clinical outcomes. For the last two decades, pulmonary vein isolation (PVI) has remained the cornerstone of the ablation procedure, with single procedure success rates as high as 90% in patients with paroxysmal AF. These favorable outcomes have not translated to patients with persistent AF, who harbor more atrial remodeling and who may require ablation beyond PVI. While most PVI-adjunctive ablation strategies have not survived the rigor of randomized control trials, in 2020, VENUS showed that adjunctive ethanol instillation into the vein of Marshall (EIVOM) improved clinical outcomes in patients with persistent AF. Since VENUS, three other randomized trials have consistently shown a benefit of adjunctive EIVOM, though utilization of this technique remains low due to a multitude of factors. In parallel to the mounting evidence supporting EIVOM, pulsed-field ablation (PFA) has revolutionized the landscape and has called into question the ongoing role of EIVOM. This review examines the electrophysiologic significance of the VOM and summarizes the clinical evidence supporting adjunctive EIVOM in the era of PFA.<\/jats:p>","DOI":"10.3390\/jcm15051848","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T10:24:34Z","timestamp":1772447074000},"page":"1848","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Role of Ethanol Ablation of the Vein of Marshall in the Era of Pulsed Field Ablation"],"prefix":"10.3390","volume":"15","author":[{"given":"Muazzum M.","family":"Shah","sequence":"first","affiliation":[{"name":"Section of Cardiac Electrophysiology, Division of Cardiology, University of Michigan, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aman","family":"Chugh","sequence":"additional","affiliation":[{"name":"Section of Cardiac Electrophysiology, Division of Cardiology, University of Michigan, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,28]]},"reference":[{"key":"ref_1","first-page":"euaf027","article-title":"Global, regional, and national burden of atrial fibrillation and atrial flutter from 1990 to 2021: Sex differences and global burden projections to 2046\u2014A systematic analysis of the Global Burden of Disease Study 2021","volume":"27","author":"Tan","year":"2025","journal-title":"EP Eur."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/j.hroo.2022.07.010","article-title":"Healthcare utilization and costs associated with a diagnosis of incident atrial fibrillation","volume":"3","author":"Deshmukh","year":"2022","journal-title":"Heart Rhythm O2"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1001\/jama.2024.22451","article-title":"Atrial Fibrillation: A Review","volume":"333","author":"Ko","year":"2025","journal-title":"JAMA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2824","DOI":"10.1093\/eurheartj\/ehae373","article-title":"Atrial fibrillation burden: A new outcome predictor and therapeutic target","volume":"45","author":"Becher","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.amjcard.2023.11.052","article-title":"Ablation Versus Antiarrhythmic Drugs as First-Line Therapy for Treatment-Naive Atrial Fibrillation: A Systematic Review and Meta-Analysis","volume":"213","author":"Ullah","year":"2024","journal-title":"Am. J. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1842","DOI":"10.1111\/jce.15106","article-title":"Pulmonary vein isolation guided by moderate ablation index targets combined with strict procedural endpoints for patients with paroxysmal atrial fibrillation","volume":"32","author":"Wang","year":"2021","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_7","first-page":"f366","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":"EP Eur."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1161\/CIRCULATIONAHA.116.026054","article-title":"Treatment of Patients With Atrial Fibrillation and Heart Failure With Reduced Ejection Fraction","volume":"135","author":"Verma","year":"2017","journal-title":"Circulation"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2296","DOI":"10.1001\/jama.2022.8831","article-title":"Effect of MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation: The DECAAF II Randomized Clinical Trial","volume":"327","author":"Marrouche","year":"2022","journal-title":"JAMA"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1001\/jama.2022.23722","article-title":"Effect of Catheter Ablation Using Pulmonary Vein Isolation With vs Without Posterior Left Atrial Wall Isolation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation: The CAPLA Randomized Clinical Trial","volume":"329","author":"Kistler","year":"2023","journal-title":"JAMA"},{"key":"ref_11","doi-asserted-by":"crossref","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":"Peterson","year":"2020","journal-title":"JAMA"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/j.jacep.2023.11.027","article-title":"Efficiency and Durability of EIVOM on Acute Reconnection After Mitral Isthmus Bidirectional Block","volume":"10","author":"Zuo","year":"2024","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1001\/jama.2024.24438","article-title":"Pulmonary Vein Isolation With Optimized Linear Ablation vs Pulmonary Vein Isolation Alone for Persistent AF: The PROMPT-AF Randomized Clinical Trial","volume":"333","author":"Sang","year":"2025","journal-title":"JAMA"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e013427","DOI":"10.1161\/CIRCEP.124.013427","article-title":"Marshall-Plan Ablation Strategy Versus Pulmonary Vein Isolation in Persistent AF: A Randomized Controlled Trial","volume":"18","author":"Derval","year":"2025","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3014","DOI":"10.1111\/jce.70090","article-title":"Ethanol Infusion in the Vein of Marshall for Persistent Atrial Fibrillation Ablation: Evidence From Randomized Controlled Trials","volume":"36","author":"Saleiro","year":"2025","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2020","DOI":"10.1038\/s41591-024-03114-3","article-title":"Safety of pulsed field ablation in more than 17,000 patients with atrial fibrillation in the MANIFEST-17K study","volume":"30","author":"Ekanem","year":"2024","journal-title":"Nat. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.1056\/NEJMoa2502280","article-title":"Pulsed Field or Cryoballoon Ablation for Paroxysmal Atrial Fibrillation","volume":"392","author":"Reichlin","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1660","DOI":"10.1056\/NEJMoa2307291","article-title":"Pulsed Field or Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation","volume":"389","author":"Reddy","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.jacc.2025.10.051","article-title":"Multicenter Study on the Safety of Pulsed Field Ablation in Over 40,000 Patients","volume":"87","author":"Turagam","year":"2026","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1016\/j.hrthm.2021.03.032","article-title":"Vein of Marshall ethanol infusion in the treatment of atrial fibrillation: From concept to clinical practice","volume":"18","year":"2021","journal-title":"Heart Rhythm"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"O\u2019Neill, L., De Becker, B., De Smet, M., Francois, C., Tavernier, R., Duytschaever, M., Le Polain De Waroux, J.-B., and Knecht, S. (2024). Vein of Marshall Ethanol Infusion for AF Ablation; A Review. J. Clin. Med., 13.","DOI":"10.3390\/jcm13082438"},{"key":"ref_22","first-page":"133","article-title":"VI. On the development of the great anterior veins in man and mammalia; including an account of certain remnants of f\u0153tal structure found in the adult, a comparative view of these great veins the different mammalia, and an analysis of their occasional peculiarities in the human subject","volume":"140","author":"Marshall","year":"1850","journal-title":"Philos. Trans. R. Soc. Lond."},{"key":"ref_23","doi-asserted-by":"crossref","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":"ref_24","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1016\/S0735-1097(00)00819-6","article-title":"The ligament of Marshall: A structural analysis in human hearts with implications for atrial arrhythmias","volume":"36","author":"Kim","year":"2000","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1111\/j.1540-8167.2006.00375.x","article-title":"Diverse Myocardial Extension and Autonomic Innervation on Ligament of Marshall in Humans","volume":"17","author":"Makino","year":"2006","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"S35","DOI":"10.1016\/j.hrthm.2009.08.034","article-title":"Ligament of Marshall: Why it is important for atrial fibrillation ablation","volume":"6","author":"Hwang","year":"2009","journal-title":"Heart Rhythm"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/j.hrthm.2015.10.018","article-title":"Ligament and vein of Marshall: A therapeutic opportunity in atrial fibrillation","volume":"13","author":"Schurmann","year":"2016","journal-title":"Heart Rhythm"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1007\/s00276-025-03691-z","article-title":"Anatomy of the oblique vein of the left atrium: Contribution of microCT analysis of human hearts","volume":"47","author":"Delgove","year":"2025","journal-title":"Surg. Radiol. Anat."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1016\/j.hrthm.2010.02.028","article-title":"Electrophysiological characteristics of the Marshall bundle in humans","volume":"7","author":"Han","year":"2010","journal-title":"Heart Rhythm"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1111\/j.1540-8167.1999.tb00240.x","article-title":"Idiopathic Paroxysmal Atrial Fibrillation Induced by a Focal Discharge Mechanism in the Left Superior Pulmonary Vein: Possible Roles of the Ligament of Marshall","volume":"10","author":"Hwang","year":"1999","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1111\/j.1540-8167.2006.00542.x","article-title":"Marshall Vein as Arrhythmogenic Source in Patients with Atrial Fibrillation: Correlation Between its Anatomy and Electrophysiological Findings","volume":"17","author":"Kurotobi","year":"2006","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.hrthm.2017.07.033","article-title":"Spectrum of atrial arrhythmias using the ligament of Marshall in patients with atrial fibrillation","volume":"15","author":"Chugh","year":"2018","journal-title":"Heart Rhythm"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1016\/j.hrthm.2024.08.053","article-title":"Activation patterns and electrophysiologic characteristics of Marshall bundle\u2013related left atrial tachycardias after atrial fibrillation ablation","volume":"22","author":"Zhang","year":"2025","journal-title":"Heart Rhythm"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"H1629","DOI":"10.1152\/ajpheart.00139.2007","article-title":"The ligament of Marshall as a parasympathetic conduit","volume":"293","author":"Ulphani","year":"2007","journal-title":"Am. J. Physiol.-Heart Circ. Physiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1111\/j.1540-8167.2008.01159.x","article-title":"Inducibility of Atrial and Ventricular Arrhythmias Along the Ligament of Marshall: Role of Autonomic Factors","volume":"19","author":"Lin","year":"2008","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1111\/j.1540-8167.2008.01315.x","article-title":"Autonomic Elements within the Ligament of Marshall and Inferior Left Ganglionated Plexus Mediate Functions of the Atrial Neural Network","volume":"20","author":"Lin","year":"2009","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1892","DOI":"10.1016\/j.jacc.2014.01.032","article-title":"Ethanol Infusion in the Vein of Marshall Leads to Parasympathetic Denervation of the Human Left Atrium","volume":"63","author":"Keida","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1111\/j.1540-8167.2005.50192.x","article-title":"Left Mitral Isthmus Ablation Associated with PV Isolation: Long-Term Results of a Prospective Randomized Study","volume":"16","author":"Fassini","year":"2005","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1056\/NEJMoa050955","article-title":"Circumferential Pulmonary-Vein Ablation for Chronic Atrial Fibrillation","volume":"354","author":"Oral","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2871","DOI":"10.1093\/eurheartj\/ehl093","article-title":"Substrate modification combined with pulmonary vein isolation improves outcome of catheter ablation in patients with persistent atrial fibrillation: A prospective randomized comparison","volume":"27","author":"Willems","year":"2006","journal-title":"Eur. Heart J."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1161\/CIRCEP.108.774885","article-title":"Long-Term Clinical Results of 2 Different Ablation Strategies in Patients With Paroxysmal and Persistent Atrial Fibrillation","volume":"1","author":"Gaita","year":"2008","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2359","DOI":"10.1093\/eurheartj\/ehn302","article-title":"Left atrial linear lesions are required for successful treatment of persistent atrial fibrillation","volume":"29","author":"Knecht","year":"2008","journal-title":"Eur. Heart J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.hrthm.2010.10.015","article-title":"Comparison of voltage map-guided left atrial anterior wall ablation versus left lateral mitral isthmus ablation in patients with persistent atrial fibrillation","volume":"8","author":"Pak","year":"2011","journal-title":"Heart Rhythm"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1404","DOI":"10.1016\/j.hrthm.2011.04.030","article-title":"Impact of mitral isthmus anatomy on the likelihood of achieving linear block in patients undergoing catheter ablation of persistent atrial fibrillation","volume":"8","author":"Yokokawa","year":"2011","journal-title":"Heart Rhythm"},{"key":"ref_45","first-page":"f401","article-title":"Evaluation of left atrial linear ablation using contiguous and optimized radiofrequency lesions: The ALINE study","volume":"20","author":"Wolf","year":"2018","journal-title":"EP Eur."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1111\/j.1540-8159.2009.02625.x","article-title":"Effect of Mitral Isthmus Block on Development of Atrial Tachycardia Following Ablation for Atrial Fibrillation","volume":"33","author":"Anousheh","year":"2010","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1016\/j.hrthm.2021.01.006","article-title":"Catheter ablation of the left and right atrial appendages without isolation in persistent atrial fibrillation","volume":"18","author":"Ghannam","year":"2021","journal-title":"Heart Rhythm"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1161\/CIRCEP.108.818427","article-title":"Retrograde Ethanol Infusion in the Vein of Marshall","volume":"2","author":"Chen","year":"2009","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1111\/j.1540-8167.2011.02268.x","article-title":"Role of the Vein of Marshall in Atrial Fibrillation Recurrences After Catheter Ablation: Therapeutic Effect of Ethanol Infusion","volume":"23","author":"Dave","year":"2012","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1016\/j.hrthm.2012.03.008","article-title":"Ethanol infusion in the vein of Marshall facilitates mitral isthmus ablation","volume":"9","author":"Morales","year":"2012","journal-title":"Heart Rhythm"},{"key":"ref_51","doi-asserted-by":"crossref","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":"ref_52","first-page":"2183","article-title":"Catheter ablation for atrial fibrillation: Results from a European survey","volume":"22","author":"Sousa","year":"2025","journal-title":"Heart Rhythm"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1687","DOI":"10.1111\/jce.15573","article-title":"Distribution of atrial low voltage induced by vein of Marshall ethanol infusion","volume":"33","author":"Kamakura","year":"2022","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_54","first-page":"euae134","article-title":"State-of-the-art pulsed field ablation for cardiac arrhythmias: Ongoing evolution and future perspective","volume":"26","author":"Chun","year":"2024","journal-title":"EP Eur."},{"key":"ref_55","first-page":"euad185","article-title":"EUropean real-world outcomes with Pulsed field ablatiOn in patients with symptomatic atRIAl fibrillation: Lessons from the multi-centre EU-PORIA registry","volume":"25","author":"Schmidt","year":"2023","journal-title":"EP Eur."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.1161\/CIRCULATIONAHA.124.070333","article-title":"Pulsed Field Ablation to Treat Paroxysmal Atrial Fibrillation: Safety and Effectiveness in the AdmIRE Pivotal Trial","volume":"150","author":"Reddy","year":"2024","journal-title":"Circulation"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1161\/CIRCULATIONAHA.125.074485","article-title":"Pulsed Field Ablation of Persistent Atrial Fibrillation With Continuous Electrocardiographic Monitoring Follow-Up: ADVANTAGE AF Phase 2","volume":"152","author":"Reddy","year":"2025","journal-title":"Circulation"},{"key":"ref_58","first-page":"e013982","article-title":"Insights Into Early Adoption and Physician Learning Curve of Pulsed Field Ablation in the United States","volume":"18","author":"Hincapie","year":"2025","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1016\/j.jacep.2023.03.021","article-title":"Pulsed-Field Ablation on Mitral Isthmus in Persistent Atrial Fibrillation","volume":"9","author":"Davong","year":"2023","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1786","DOI":"10.1016\/j.jacep.2023.04.002","article-title":"A Focal Ablation Catheter Toggling Between Radiofrequency and Pulsed Field Energy to Treat Atrial Fibrillation","volume":"9","author":"Reddy","year":"2023","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_61","first-page":"e014026","article-title":"Feasibility and Safety of Pulsed Field Ablation for Coronary Sinus and Left Atrial Appendage Isolation and Mitral Isthmus Ablation: Acute and Chronic Findings","volume":"18","author":"Mohanty","year":"2025","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1097\/HCO.0000000000001181","article-title":"Coronary artery injury in pulsed field ablation","volume":"40","author":"Higuchi","year":"2025","journal-title":"Curr. Opin. Cardiol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1016\/j.jacep.2025.03.014","article-title":"Effect of Pulsed-Field Ablation on Human Coronary Arteries","volume":"11","author":"Tam","year":"2025","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_64","first-page":"H805","article-title":"Differing sympathetic and vagal effects on atrial fibrillation in dogs: Role of refractoriness heterogeneity","volume":"273","author":"Liu","year":"1997","journal-title":"Am. J. Physiol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1111\/j.1540-8167.2006.00679.x","article-title":"Gradients of Atrial Refractoriness and Inducibility of Atrial Fibrillation due to Stimulation of Ganglionated Plexi","volume":"18","author":"Zhou","year":"2007","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"2774","DOI":"10.1161\/01.CIR.102.22.2774","article-title":"Catheter ablation of cardiac autonomic nerves for prevention of vagal atrial fibrillation","volume":"102","author":"Schauerte","year":"2000","journal-title":"Circulation"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1016\/j.hrthm.2009.05.018","article-title":"Selective ganglionated plexi ablation for paroxysmal atrial fibrillation","volume":"6","author":"Pokushalov","year":"2009","journal-title":"Heart Rhythm"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"3039","DOI":"10.1111\/jce.14258","article-title":"Different effects of additional ganglion plexus ablation on catheter and surgical ablation for atrial fibrillation: A systemic review and meta-analysis","volume":"30","author":"Yan","year":"2019","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1864","DOI":"10.1016\/j.jacep.2023.05.035","article-title":"Impact of Pulsed-Field Ablation on Intrinsic Cardiac Autonomic Nervous System After Pulmonary Vein Isolation","volume":"9","author":"Tohoku","year":"2023","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1016\/j.jacep.2022.10.028","article-title":"Pulsed Field Ablation to Treat Atrial Fibrillation","volume":"9","author":"Musikantow","year":"2023","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1634","DOI":"10.1016\/j.jacep.2024.05.005","article-title":"Autonomic Effects of Pulsed Field vs Thermal Ablation for Treating Atrial Fibrillation","volume":"10","author":"Gerstenfeld","year":"2024","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"S811","DOI":"10.1016\/j.hrthm.2025.03.1932","article-title":"AB-514135-004 Pulsed-Field Ablation of the Mitral Isthmus: Transmurality and Autonomic Effects Validated with Vein of Marshall Recordings","volume":"22","author":"Patel","year":"2025","journal-title":"Heart Rhythm"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.jacep.2021.11.019","article-title":"Vein of Marshall Ethanol Infusion as First Step for Mitral Isthmus Linear Ablation","volume":"8","author":"Gillis","year":"2022","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1111\/pace.14617","article-title":"Vein of Marshall ethanol infusion: First-step or adjunctive choice for perimitral atrial tachycardia?","volume":"46","author":"Gao","year":"2023","journal-title":"Pacing Clin. Electrophysiol. PACE"},{"key":"ref_75","unstructured":"Knecht, S. (2025, December 01). Posterior Mitral Isthmus Line with Vein of Marshall Ethanolisation Compared with Anterior Mitral Lines in Patients With Persistent Atrial Fibrillation, Available online: https:\/\/clinicaltrials.gov\/study\/NCT06962176."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"e010001","DOI":"10.1161\/CIRCEP.121.010001","article-title":"Vein of Marshall Ethanol Infusion","volume":"14","author":"Kamakura","year":"2021","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Zhang, H.-D., Ding, L., Zhang, K., Yu, F.-Y., Mi, L.-J., Weng, S.-X., Jiang, Z.-H., and Tang, M. (2023). Double-wire technique to facilitate vein of Marshall cannulation and ethanol infusion in atrial fibrillation: A case series. BMC Cardiovasc. Disord., 23.","DOI":"10.1186\/s12872-023-03553-9"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1016\/j.jacep.2022.04.004","article-title":"A Novel Balloon-Based Catheter for Venous Ethanol Ablation","volume":"8","author":"Krisai","year":"2022","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_79","unstructured":"Hospital Center University de Bordeaux (2025, December 01). Prospective Single-Centre Study to Evaluate the Feasibility of Ethanolization of Vein of Marshall with a Specific Catheter in the Ablation of Atrial Fibrillation, Available online: https:\/\/clinicaltrials.gov\/study\/NCT05427435."},{"key":"ref_80","unstructured":"Sang, C. (2025, December 01). Marshall Vein Ethanol Infusion in Addition to Pulsed Electric Field Ablation Versus Pulsed Electric Field Ablation Alone for Paroxysmal Atrial Fibrillation, Available online: https:\/\/clinicaltrials.gov\/study\/NCT07095959."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/1848\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T10:48:24Z","timestamp":1772448504000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/1848"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,28]]},"references-count":80,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcm15051848"],"URL":"https:\/\/doi.org\/10.3390\/jcm15051848","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,28]]}}}