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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

  • Nicolas Derval
    Correspondence
    Address reprint requests and correspondence: Dr Nicolas Derval, CHU Bordeaux, Hôpital Cardiologique du Haut-Lévêque, 33604 Bordeaux-Pessac, France.
    Affiliations
    IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France

    Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France
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  • Josselin Duchateau
    Affiliations
    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
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  • Arnaud Denis
    Affiliations
    IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France

    Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France
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  • F. Daniel Ramirez
    Affiliations
    IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France

    Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France
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  • Saagar Mahida
    Affiliations
    Liverpool Centre for Cardiovascular Science and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
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  • Clémentine André
    Affiliations
    IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France

    Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France
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  • Philipp Krisai
    Affiliations
    IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France

    Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France
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  • Yosuke Nakatani
    Affiliations
    IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France

    Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France
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  • Takeshi Kitamura
    Affiliations
    IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France

    Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France
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  • Masateru Takigawa
    Affiliations
    IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France

    Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France
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  • Remi Chauvel
    Affiliations
    IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France

    Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France
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  • Romain Tixier
    Affiliations
    IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France

    Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France
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  • Xavier Pillois
    Affiliations
    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
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  • Frédéric Sacher
    Affiliations
    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
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  • Mélèze Hocini
    Affiliations
    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
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  • Michel Haïssaguerre
    Affiliations
    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
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  • Pierre Jaïs
    Affiliations
    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
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  • Thomas Pambrun
    Affiliations
    IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France

    Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France
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Published:December 28, 2020DOI:https://doi.org/10.1016/j.hrthm.2020.12.023

      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.

      Keywords

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