Univu-guided Vein of Marshall Ethanol Infusion (Marshall-Merge)

Image Fusion of Integrating Fluoroscopy Into 3D Computed Tomography in Guidance of Vein of Marshall Ethanol Infusion During Persistent Atrial Fibrillation Ablation

The study is a prospective, randomized, single-blind clinical trial aiming to compare two method in guidance of Vein of Marshall ethanol infusion (VOMEI), i.e., the conventional fluoroscopy-guided VOMEI and UNIVU-guided VOMEI.

A total of 100 participants with persistent or longstanding persistent AF who undergo radiofrequency catheter ablation will be randomized assigned to two groups at 1:1 ratio to receive Vein of Marshall ethanol infusion (VOMEI).

Group 1: VOMEI guided by fluroscopy alone Group 2: VOMEI guided by fluoroscopy and CARTO UNIVU The intraprocedural major endpoints are the change in low-voltage area led by VOMEI (efficacy endpoint) and procedural complications (safety endpoint). The longterm major endpoint is the recurrence of atrial tachyarrhythmia between 3 and 12 months.

Inclusion Criteria:

• Age between 18 and 85 years
• Sympathetic atrial fibrillation without previous ablation
• Persistent or long-standing persistent AF
• Patients' willing to undergo catheter ablation and VOMEI

Exclusion Criteria:

• Left atrial or left atrial appendage thrombus
• LVEF <30%
• Cardiac surgery within 90 days
• Myocardial infarction within 90 days
• PCI or PTCA within 90 days
• Thromboembolic events within 90 days, including stroke, pulmonary embolism, systemic embolism
• Atrial myxoma
• Congenital heart disease
• Pregnant or pregnant plan
• Acute or severe infection
• Creatine> 221 μmol/L, or GFR <30 ml/min/1.73 m.
• Unstable angina
• Blood-clotting or bleeding disorder
• Contraindication to anticoagulation
• Life expectancy less than 1 year
• Uncontrolled heart failure
• Uncontrolled malignant tumor
• Malformation of femoral vascular access
• Without consent