Venous Ethanol Infusion for the Ablation of Atrial Fibrillation: A Step-by-Step Guide

Pulmonary vein isolation (PVI) alone has limited success in treating persistent atrial fibrillation (AF), prompting the use of adjunctive strategies like vein of Marshall (VOM) ethanol infusion to improve outcomes. This step-by-step guide outlines a standardized approach for VOM ethanol infusion, including venous access, coronary sinus cannulation, VOM identification, and ethanol infusion via an over-the-wire balloon catheter. Ethanol infusion enhances ablation efficacy, reducing AF recurrence and improving the likelihood of durable mitral isthmus block. By providing a reproducible framework, this guide helps electrophysiologists integrate VOM ethanol ablation into clinical practice, optimizing rhythm control strategies for complex AF patients.