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Marshall bundle elimination, Pulmonary vein isolation, and Line completion for ANatomical ablation of persistent atrial fibrillation (Marshall-PLAN): Prospective, single-center study.

Author information

Affiliations

  • 1. IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France.
      Authors
    • Derval N 1
    • Denis A 1
    • Ramirez FD 1
    • André C 1
    • Krisai P 1
    • Nakatani Y 1
    • Kitamura T 1
    • Takigawa M 1
    • Chauvel R 1
    • Tixier R 1
    • Pambrun T 1
    (11 authors)
  • 2. IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.
      Authors
    • Duchateau J 2
    • Pillois X 2
    • Sacher F 2
    • Hocini M 2
    • Haïssaguerre M 2
    • Jaïs P 2
    (6 authors)
  • 3. Liverpool Centre for Cardiovascular Science and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
      Authors
    • Mahida S 3
    (1 author)

ORCIDs linked to this article

Heart Rhythm, 29 Dec 2020, 18(4):529-537
https://doi.org/10.1016/j.hrthm.2020.12.023 PMID: 33383226 

Abstract 

Background

Beyond pulmonary vein isolation (PVI), the optimal ablation strategy for persistent atrial fibrillation (AF) remains poorly defined.

Objective

The purpose of this study was to examine a novel comprehensive ablation strategy (Marshall bundle elimination, Pulmonary vein isolation, and Line completion for ANatomical ablation of persistent atrial fibrillation [Marshall-PLAN]) strictly based on anatomical considerations.

Methods

Left atrial (LA) sites were sequentially targeted as follows: (1) coronary sinus and vein of Marshall (CS-VOM) musculature; (2) PVI; and (3) anatomical isthmuses (mitral, roof, and cavotricuspid isthmus [CTI]). The primary endpoint was 12-month freedom from AF/atrial tachycardia (AT).

Results

Seventy-five consecutive patients were included (age 61 ± 9 years; 10 women; AF duration 9 ± 11 months; mean LA volume 197 ± 43 mL). VOM ethanol infusion was completed in 69 patients (92%). The full Marshall-PLAN lesion set (VOM, PVI, mitral, roof, and CTI with block) was successfully completed in 68 patients (91%). At 12 months, 54 of 75 patients (72%) were free from AF/AT after a single procedure (no antiarrhythmic drugs) in the overall cohort. In the subset of patients with a complete Marshall-PLAN lesion set (n = 68), the single procedure success rate was 79%. After 1 or 2 procedures, 67 of 75 patients (89%) remained free from AF/AT (no antiarrhythmic drugs). After 1 or 2 procedures, VOM ethanol infusion was complete in 72 of 75 patients (96%).

Conclusion

A novel ablation strategy that systematically targets anatomical atrial structures (VOM ethanol infusion, PVI, and prespecified linear lesions) is feasible, safe, and associated with a high rate of freedom from arrhythmia recurrence at 12 months in patients with persistent AF.

Full text links 

Read article at publisher's site: https://doi.org/10.1016/j.hrthm.2020.12.023

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Funding 

Funders who supported this work.

Agence Nationale de la Recherche

    CIHR