Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Ablation Techniques D-PO01 - Featured Poster Session (ID 11) Poster

D-PO01-132 - Outcomes And Predictors Of Arrhythmia Recurrence Using The Marshall-PLAN Ablation Strategy For Persistent Atrial Fibrillation (ID 106)


Background: Outcomes of common catheter ablation strategies for persistent atrial fibrillation (PsAF) are suboptimal. Strategies involving extensive substrate ablation can decrease the risk of recurrent AF but have the potential to increase the risk of reentrant atrial tachycardia (AT).
Objective: (1) To examine the effectiveness of an anatomical approach to catheter ablation for PsAF that incorporates ethanol infusion into the vein of Marshall (VOM), pulmonary vein isolation, and three linear lesions, with lesion set completion as the procedural endpoint (the Marshall-PLAN); and (2) to identify predictors of recurrent atrial tachyarrhythmias.
Methods: All patients with PsAF undergoing index catheter ablation using the Marshall-PLAN strategy over 16 months at our center were included. The composite of recurrent AF/AT or repeat left atrial ablation following a 90-day period after the index procedure was assessed using Kaplan-Meier estimates. Candidate patient and procedural predictors of recurrent AF/AT were examined via prespecified univariable and multivariable Cox regression models.
Results: One hundred eight patients were included (age 62 ± 9 years, 85% male). VOM ethanol infusion could be performed in 103 cases (95%). AF termination during ablation occurred in 22/82 patients (27%). Over a median follow-up of 12 (IQR 7-13) months, 29 patients (27%) had recurrent AF/AT, 22 of whom underwent repeat ablation using the same ablation strategy (12-month Kaplan-Meier event rate estimate for the composite outcome: 29%). At last follow-up, 94 patients (87%) were in sinus rhythm, 87 (93%) of whom were not on antiarrhythmic drugs. Successful VOM ethanol infusion predicted freedom from recurrent arrhythmia or repeat ablation in both crude and adjusted analyses (crude HR 0.27, 95% CI 0.10-0.79; P=0.017; adjusted HR 0.19, 95% CI 0.06-0.60; P=0.005 [model 1]; adjusted HR 0.16, 95% CI 0.04-0.56, P=0.005 [model 2]). Age, sex, body mass index, left atrial volume, AF cycle length, and AF termination during ablation were not predictive of arrhythmia recurrence.
Conclusion: This study demonstrates the feasibility of the MARSHALL-Plan ablation strategy for PsAF and suggests that it is effective over the medium term. VOM ethanol infusion appears to be important to its success.