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Complication Following Vein of Marshall Ethanol Ablation: A Case of Acute Cardiogenic Shock and Death
Journal article   Open access   Peer reviewed

Complication Following Vein of Marshall Ethanol Ablation: A Case of Acute Cardiogenic Shock and Death

Ghazaleh Goldar, Aaron Sifuentes, Sean Byrnes, Peter Farjo and Paari Dominic
HeartRhythm case reports, Vol.11(9), pp.838-842
09/2025
DOI: 10.1016/j.hrcr.2025.05.029
PMCID: PMC12666916
PMID: 41333943
url
https://doi.org/10.1016/j.hrcr.2025.05.029View
Published (Version of record) Open Access

Abstract

Key Teaching Points:1.Severe complications and unclear cause of Hemodynamic Collapse – While VOM ethanol infusion is generally well tolerated, this case highlights the rare but severe risk of acute cardiogenic shock, with no clear mechanism identified despite extensive testing. Possible mechanisms include coronary thrombus, vasospasm, AV malformation, or another unidentified pathway. 2.Higher Ethanol Dose – A higher dose of ethanol was used in this case compared to initial trials, as high-volume centers have adopted higher doses due to the VOM's anatomical characteristics, which allow for more controlled delivery. However, to ensure safety, it is recommended to use the lowest effective dose, administered in carefully divided increments, to minimize risks and ensure patient safety. Understanding the patient's anatomy through methods like CT or electroanatomical mapping can potentially help tailor the ethanol volume and infusion rate to reduce risks and enhance safety. 3.Importance of Close Hemodynamic Monitoring and Access to Emergent Interventions - During VOM ethanol infusion continuous monitoring is crucial, and operators should be prepared for emergent intervention, including mechanical circulatory support devices, to prevent catastrophic outcomes.
 Cardiovascular

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