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

The Marshall Plan, an ablation strategy designed to perform a complete lesion set in patients with AF, consists of the following steps:

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

Thomas Pambrun, MD, and colleagues conducted the prospective PLAN-MARSHALL trial, randomizing 120 patients with persistent AF 1:1 to the Marshall Plan strategy for ablation or to PVI alone. They presented their finding at the 2023 European Heart Rhythm Association (EHRA) Congress, held from April 16-18, in Barcelona, Spain¹.

The primary endpoint was the recurrence of AF or atrial tachycardia (AT) greater than 30 seconds at 12 months. According to the findings, 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 (logrank statistic 4.32; P=0.038). Dr. Pambrun pointed out that the results suggested AF recurrence is relatively more common in the PVI arm (94% vs 75% of the recurrences), whereas TA was relatively more common in the Marshall Plan arm (25% vs 6%).

“Interestingly, looking at redo procedures, all nine patients in the PVI group had all four 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.” Regarding complications, one case of oeso-pericardial fistula was reported in the PVI arm, and one massive groin hematoma was observed in the Marshall Plan arm.

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