ICE-guided VOM ethanol infusion enhances procedural precision, reduces radiation exposure, and achieves more extensive substrate modification compared with venography, though clinical recurrence rates at 12 months were similar between groups.
Key Findings
Results
ICE-guided VOM ethanol infusion produced significantly larger ethanol-induced low-voltage areas compared to venography-guided procedures.
Study included 126 patients total: 42 ICE-guided and 84 venography-guided, matched via propensity score matching (1:2)
The difference in ethanol-induced low-voltage area (LVA) was statistically significant (p < 0.05)
ICE guidance utilized real-time monitoring of ethanol-induced tissue changes, whereas venography relied on contrast extravasation
The retrospective matched cohort design balanced baseline characteristics between groups
Results
ICE-guided procedures demonstrated significantly improved procedural efficiency, including shorter total procedure times and reduced fluoroscopy times.
Total procedure duration was shorter in the ICE-guided group (p < 0.05)
Fluoroscopy time was reduced in the ICE-guided group (p < 0.05)
VOM ethanol infusion times were shorter in the ICE-guided group (p < 0.05)
Mitral isthmus (MI) ablation times were shorter in the ICE-guided group (p < 0.05)
Radiation exposure was lower in the ICE-guided group (p < 0.05)
Results
Major complications were rare and similar between ICE-guided and venography-guided groups.
No statistically significant difference in major complications between groups (p = 0.719)
ICE guidance was noted to improve safety by avoiding distal VOM cannulation, which carries procedural risks associated with traditional venography
The study population included 126 patients undergoing de novo radiofrequency catheter ablation for persistent AF
Results
Freedom from AF/atrial tachycardia recurrence at 12 months was comparable between ICE-guided and venography-guided groups.
Log-rank test p = 0.66, indicating no statistically significant difference in 12-month recurrence between groups
The clinical endpoint measured was freedom from AF/AT recurrence at 12 months
Despite larger LVAs and improved procedural efficiency with ICE guidance, clinical recurrence rates were similar
The authors note the nonrandomized design and small sample size as limitations warranting further validation in randomized trials
Background
Traditional venography-guided VOM ethanol infusion does not allow real-time evaluation of ethanol distribution and carries procedural risks, motivating the development of ICE-guided approaches.
VOM ethanol infusion is described as an adjunctive strategy for persistent AF ablation, traditionally guided by VOM venography
Venography relies on contrast extravasation rather than real-time tissue visualization
ICE provides high-resolution visualization for precise guidance but was described as remaining understudied clinically at the time of the study
ICE guidance allows real-time monitoring of ethanol-induced tissue changes
Huang X, Li X, Feng J, Zhang W, Li X. (2026). A Novel Intracardiac Echocardiography-Guided Approach for Vein of Marshall Ethanol Infusion in Persistent Atrial Fibrillation Ablation.. Cardiovascular therapeutics. https://doi.org/10.1155/cdr/9390824