Related Experiment Video
Updated: Jun 20, 2026
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Robotic Ablation of Atrial Fibrillation
Published on: May 29, 2015
Sequential vs First-Intention Marshall-PLAN Strategy in Persistent Atrial Fibrillation Ablation: A Propensity Score
Grégoire Massoullié1, Saer Abu-Alrub1, Louise Julhes2
1Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France.
JACC. Clinical Electrophysiology
|June 19, 2026
Summary
The Marshall-PLAN ablation strategy, combining pulmonary vein isolation and ethanol infusion of the vein of Marshall, shows similar effectiveness whether performed initially or after a prior procedure. Completing the Marshall-PLAN is key for maintaining sinus rhythm in persistent atrial fibrillation.
Area of Science:
- Electrophysiology
- Cardiac Ablation Techniques
- Atrial Fibrillation Management
Background:
- The Marshall-PLAN ablation approach, integrating pulmonary vein isolation (PVI) with ethanol infusion of the vein of Marshall (Et-VOM) and linear lesions, is recognized for improving rhythm outcomes in persistent atrial fibrillation (PsAF).
- However, the added benefits and optimal timing for implementing the Marshall-PLAN strategy remain subjects of ongoing clinical debate.
Purpose of the Study:
- To compare the efficacy of the Marshall-PLAN ablation strategy when utilized as an initial treatment versus a secondary procedure following a prior PVI for persistent atrial fibrillation.
- To evaluate the impact of procedural timing and completeness on long-term rhythm control in PsAF patients.
Main Methods:
- A retrospective analysis of 237 patients with PsAF treated between September 2022 and April 2025.
- Patients were divided into two groups: first-intention Marshall-PLAN (n=168) and sequential Marshall-PLAN after prior PVI (n=69).
- Primary endpoint was arrhythmia recurrence (≥30 seconds), with analyses adjusted using inverse probability of treatment weighting (IPTW).
Main Results:
- Ethanol infusion of the vein of Marshall (Et-VOM) achieved success in 92.8% of cases.
- At 12 months, arrhythmia-free survival rates were comparable: 74.3% for the first-intention group and 80.7% for the sequential group (IPTW P=0.95).
- Incomplete Marshall-PLAN was significantly associated with recurrence (HR: 5.55), while the sequential strategy was not (HR: 0.52). Increased left atrial volume predicted recurrence (HR: 1.01).
Conclusions:
- In patients with persistent atrial fibrillation, a sequential Marshall-PLAN procedure after prior PVI offers comparable arrhythmia control to a first-intention approach.
- The completeness of the Marshall-PLAN procedure, rather than its timing (initial vs. sequential), is the critical factor for achieving durable sinus rhythm maintenance.
