Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Clinical Trials / Outcomes D-PO03 - Poster Session III (ID 48) Poster

D-PO03-182 - Marshall Bundles Elimination, Pulmonary Veins Isolation And Lines Completion For Anatomical Ablation Of Persistent Atrial Fibrillation: Marshall-plan Study (ID 1144)


Background: Beyond pulmonary veins (PV) isolation, the ablation strategy for persistent atrial fibrillation (AF) remains controversial.
Objective: We sought to investigate a new lesion set strictly based on anatomical considerations.
Methods: Three atrial structures were successively targeted: 1) coronary sinus and vein of Marshall (CS-VOM) musculature elimination (ethanol infusion and RF ablation); 2) PVs isolation; and 3) anatomical isthmuses block (mitral, roof and CTI lines). The primary endpoint is 12-months AF free outcome in comparison to a matched PVI + drivers ablation control group.
Results: 57 consecutive patients were included (61±10yo). Baseline AF duration was 8±10 months, mean LAA-CL was 180±35 and mean LA volume was 197±43ml. VOM ethanolization failed in 5 patients (not found in 3 and LAA vein ethanolization in 2). Step 1: mean time for VOM-OH: 30±10 min, 9±2 ml; mean RF time for CS-VOM bundles was 12.6±5.4 min. Step 2: mean RF time for PVI: left 7±5min; right 14±8 (p<0,001). Step 3: mean RF time for mitral, roof and CTI lines was 8±7min (block in 93%), 7±3min (block in 98%) and 8±6min (block in 100%), respectively. Mean procedure time was 276±43 min and RF duration was 54±25min. AF termination was observed in 23 patients (40%). 2 patients had TIA acutely. At 12,3±2months follow-up, 41/57 (72%) patients were free from AF/AT and 46/52 (88%) in patients with VOM ethanolization (single procedure, off AAD) compared to 16/57 (28%) patients in the control group (p<0.001).
Conclusion: We report a new ablation strategy associating systematic ethanol infusion of the VOM to PVI and lines completion. This lesions set proves to be acutely feasible and superior to a PVI + drivers ablation strategy.