Novel ablation strategy improved arrhythmia recurrence vs. pulmonary vein isolation only
Key takeaways:
- The Marshall-Plan ablation strategy improved arrhythmia recurrence vs. pulmonary vein isolation only for persistent atrial fibrillation.
- The strategy is the first to address several targets systematically.
In a small, single-center trial, the novel Marshall-Plan ablation strategy improved 10-month arrhythmia recurrence compared with pulmonary vein isolation alone for persistent atrial fibrillation, a speaker reported.
“After 10 months of follow up, the success rate in the Marshall-Plan group was significantly better (87%) compared to the PVI only group (70%),” Nicolas Derval, MD, head of the electrophysiology unit at the University Hospital of Bordeaux, France, said in a press release. “However, the results are still preliminary, as follow up is not completed for all patients. While the findings indicate that the Marshall-Plan strategy holds promise for patients with persistent atrial fibrillation, they need to be confirmed in a multicenter trial.”
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The findings were presented at the Annual Congress of the European Heart Rhythm Association.
The Marshall-Plan ablation strategy consists of PVI; ethanol infusion of the vein of Marshall; and a linear ablation to block the dome, mitral and cavotricuspid isthmus lines to the pulmonary veins, according to the release.
Although they have been individually recognized as clinically significant targets for atrial fibrillation, Derval and colleagues stated they have not been collectively targeted in a systematic manner.
Therefore, the researchers undertook a prospective, randomized, parallel group trial of superiority of the Marshall-Plan ablation strategy compared with PVI only among 120 patients with persistent AF for more than 1 month (mean age, 67 years; 18% women).
Participants were followed up at 3, 6, 9 and 12 months and underwent ECG testing, echocardiography, stress testing and 24-hour Holter monitoring.
The primary outcome was 12-month arrhythmia-free survival identified using weekly ECG teletransmissions sent to the hospital and any time a patient had symptoms.
Total radiofrequency time was approximately 6 minutes longer in the PVI group compared with the Marshall-Plan group (29 vs. 23 minutes; P < .001), according to the release.
Full lesion set was successful in 88% of patients who underwent Marshall-Plan ablation and 98% of patients who underwent PVI only.
During an average follow-up of 10 months, recurrence of arrhythmias was higher among participants who underwent PVI only compared with the Marshall-Plan ablation strategy (18 vs. 8 patients P = .026).
Derval and colleagues stated that follow-up will continue through 12 months.
Reference:
- Novel ablation strategy improves freedom from arrhythmias in atrial fibrillation patients. www.escardio.org/The-ESC/Press-Office/Press-releases/novel-ablation-strategy-improves-freedom-from-arrhythmias-in-atrial-fibrillation. Published on April 18, 2023. Accessed on April 18, 2023.
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Derval N, et al. Late Breaking Science - Today and tomorrow. Presented at: EHRA: The Annual Congress of the European Heart Rhythm Association; April 16-18, 2023; Barcelona, Spain.