AUTHOR=Li Feng , Sun Jin-Yu , Wu Li-Da , Zhang Lei , Qu Qiang , Wang Chao , Qian Ling-Ling , Wang Ru-Xing 

TITLE=The Long-Term Outcomes of Ablation With Vein of Marshall Ethanol Infusion vs. Ablation Alone in Patients With Atrial Fibrillation: A Meta-Analysis

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.871654

DOI=10.3389/fcvm.2022.871654

ISSN=2297-055X

ABSTRACT=Background
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.
Methods
PubMed, Cochrane Library, Web of Science, and Embase were searched up to 1 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. 
Results
Compared with ablation alone, VOM-ABL was associated with a significantly higher rate of long-term freedom from AF/atrial tachycardia (AT) (risk ratio [RR], 1.28; 95% confidence interval [CI], 1.12-1.47; P=0.00), and successful mitral isthmus (MI) block (RR 1.52; 95% CI, 1.16-1.99; P=0.00); whereas, 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 (PVI+; RR 1.41; 95% CI, 1.27-1.56 vs PVI; RR 1.05; 95% CI, 0.92-1.19, P=0.00 for interaction) for freedom from AF/AT, while the other was VOM-ABL group sample size subgroup (≥ 100; RR 1.98; 95% CI, 1.24-3.17 vs <100; RR 1.20; 95% CI, 1.10-1.30, P=0.04 for interaction) for MI block. 
Conclusions
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 ≥ 100 may be associated with a great impact on freedom from AF/AT and MI block, respectively.