Promising results for Marshall Plan ablation strategy

Preliminary results from the PLAN-MARSHALL trial showed that the Marshall-Plan ablation strategy may outperform pulmonary vein isolation (PVI) alone with regard to the recurrence of atrial fibrillation (AF) in patients with persistent AF.

The Marshall Plan is an ablation strategy that aims to perform a complete lesion set in patients with AF, with the following steps:

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  • vein of Marshall ethanol infusion,
  • PVI,
  • mitral line block,
  • dome transection (roof or floor), and
  • cavo-tricuspid isthmus line block.

Dr Thomas Pambrun (Bordeaux University Hospital, France) and colleagues conducted the prospective, monocentric PLAN-MARSHALL trial (NCT04206982), randomising 120 patients with persistent AF 1:1 to the Marshall Plan strategy for ablation or to PVI alone. The primary endpoint was the recurrence of AF or atrial tachycardia >30 seconds at 12 months.

The current results indicated that the Marshall Plan may be superior to PVI alone: after a mean follow-up time of 10.5 months, the sinus maintenance rate was 69% in the PVI arm and 84% in the Marshall Plan arm (log-rank statistic 4.32; P=0.038). Dr Pambrun added that the results suggested that AF recurrence is relatively more common in the PVI arm (94% vs 75% of the recurrences), whereas atrial tachycardia was relatively more common in the Marshall Plan arm (25% vs 6%).

“Interestingly, looking at redo procedures, all the 9 patients in the PVI group had all 4 PV’s isolated, meaning there was no room for improvement,” said Dr Pambrun. “On the other hand, in the Marshall Plan arm, all patients who underwent redo procedures (n=6) had gaps in the lesion set, which means there is room for improvement in these patients.” Finally, in terms of complications, 1 case of oeso-pericardial fistula was reported in the PVI arm, and 1 massive groin haematoma was observed in the Marshall Plan arm.

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   1. Pambrun T, et al. Marshall-PLAN vs PV isolation: Preliminary results of the monocentric randomized trial. Late-Breaking Science – Today and Tomorrow, EHRA 2023, 16–18 April, Barcelona, Spain.

 

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Posted on 3 May 20233 May 2023