期刊
HEART RHYTHM
卷 18, 期 4, 页码 529-537出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.hrthm.2020.12.023
关键词
Anatomical approach; Catheter ablation; Ethanol infusion; Persistent atrial fibrillation; Vein of Marshall
资金
- French Government as part of the Investments for the Future program by the National Research Agency (ANR) [ANR-10-IAHU-04]
- Canadian Institutes of Health Research Banting Postdoctoral Fellowship
- University of Basel
- Mach-Gaensslen Foundation
- Bangerter-Rhyner Foundation
This study found that a novel ablation strategy targeting 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.
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.
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