Marshall-Plan Ablation Strategy Versus Pulmonary Vein Isolation in Persistent AF: A Randomized Controlled Trial

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Optimal ablation strategies for persistent atrial fibrillation (AF) beyond pulmonary vein (PV) isolation are not well-defined.
• Persistent AF management requires advanced techniques to improve patient outcomes.

Purpose of the Study:

• To compare the efficacy of the Marshall-Plan ablation strategy against pulmonary vein isolation (PVI) alone for persistent AF.
• To evaluate long-term freedom from arrhythmia after a single ablation procedure.

Main Methods:

• A prospective, randomized, controlled trial (Marshall-Plan trial) involving patients with symptomatic persistent AF.
• Two arms: Marshall-Plan (PVI + vein of Marshall ethanol infusion + linear lesions) versus PVI alone.
• Primary outcome: 1-year freedom from any atrial arrhythmia (>30 seconds) with or without antiarrhythmic medication.

Main Results:

• The Marshall-Plan strategy achieved 86.4% freedom from arrhythmia, compared to 66.1% with PVI alone (P=0.012) at 12 months.
• Successful PV isolation was achieved in all patients; vein of Marshall ethanol infusion was completed in 97% of the Marshall-Plan group.
• High rates of conduction block were achieved for linear lesions in the Marshall-Plan group.

Conclusions:

• The Marshall-Plan strategy demonstrated significant superiority over PVI alone for treating persistent AF at 12 months.
• This comprehensive approach offers a promising alternative for managing persistent atrial fibrillation.