Article Dans Une Revue Circulation. Arrhythmia and electrophysiology Année : 2025

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

Nicolas Derval
  • Fonction : Auteur
Romain Tixier
  • Fonction : Auteur
Josselin Duchateau
  • Fonction : Auteur
Xavier Bouteiller
  • Fonction : Auteur
Timothe Loock
  • Fonction : Auteur
Arnaud Denis
  • Fonction : Auteur
Remi Chauvel
  • Fonction : Auteur
Marine Arnaud
  • Fonction : Auteur
Masaaki Yokoyama
  • Fonction : Auteur
Christopher Kowalewski
  • Fonction : Auteur
Cinzia Monaco
  • Fonction : Auteur
Ciro Ascione
  • Fonction : Auteur
Frederic Sacher
  • Fonction : Auteur
Meleze Hocini
  • Fonction : Auteur
Pierre Jais
  • Fonction : Auteur
Michel Haissaguerre
  • Fonction : Auteur
Thomas Pambrun
  • Fonction : Auteur

Résumé

BACKGROUND: Beyond pulmonary vein (PV) isolation, the optimal ablation strategy for persistent atrial fibrillation (AF) remains poorly defined. The purpose of this study was to compare 2 ablation strategies in the treatment of patients with persistent AF: a comprehensive ablation strategy based on anatomic considerations versus PV isolation alone. METHODS: The Marshall-Plan trial is a prospective, randomized, parallel-group, controlled clinical trial of superiority conducted at the Bordeaux University Hospital. Consecutive patients with symptomatic, documented persistent AF were included and randomized into 2 arms: Marshall-Plan consisting of PV isolation with additional ablation including vein of Marshall ethanol infusion, and lines of block at the mitral, dome, and cavotricuspid isthmuses versus PV isolation alone. The main outcome was the 1-year freedom from any arrhythmia (atrial fibrillation/atrial tachycardia >30 seconds) after a single ablation procedure with or without any antiarrhythmic medication at 12 months. RESULTS A total of 120 patients were included (age 65 +/- 8 years; 21 women). Two patients were excluded from analysis. All PVs were successfully isolated in both groups. In the Marshall-Plan group, vein of Marshall ethanol infusion was completed in 57 (97%) patients. Conduction block across linear lesions was obtained in 93%, 92%, and 93% of the mitral, dome, and cavotricuspid isthmuses, respectively. The full lesion set was successfully completed in 52 (88%) patients in the Marshall-Plan group and 59 (100%) patients in the PV isolation group. At 12 months, freedom from recurrence of atrial arrhythmia >30 seconds after 1 ablation procedure, with or without antiarrhythmic medication, had occurred in 51 of the 59 (86.4%) patients assigned to the Marshall-Plan approach, and 39 of the 59 (66.1%) patients assigned to PV isolation only (P=0.012). CONCLUSIONS: In this prospective randomized controlled trial, the Marshall-Plan strategy was significantly superior to a PV isolation strategy at 12 months.

Fichier principal
Vignette du fichier
BPH_CAE_2025_Derval.pdf (2.31 Mo) Télécharger le fichier
Origine Publication financée par une institution
Licence

Dates et versions

hal-05149777 , version 1 (08-07-2025)

Licence

Identifiants

Citer

Nicolas Derval, Romain Tixier, Josselin Duchateau, Xavier Bouteiller, Timothe Loock, et al.. Marshall-Plan Ablation Strategy Versus Pulmonary Vein Isolation in Persistent AF: A Randomized Controlled Trial. Circulation. Arrhythmia and electrophysiology, 2025, 18 (5), pp.e013427. ⟨10.1161/circep.124.013427⟩. ⟨hal-05149777⟩
24 Consultations
90 Téléchargements

Altmetric

Partager

  • More