Arrhythmias & electrophysiology
Gaps after linear ablation of persistent atrial fibrillation (Marshall-PLAN): Clinical implication
Authors' conclusion
Gaps are arrhythmogenic and can be reduced by optimized ablation and assessment of lines of block. Closing these gaps improves sinus rhythm maintenance.
Study context
- Population
- Patients with persistent AF undergoing vein of Marshall ethanol infusion, pulmonary vein (PV) isolation, and mitral, cavotricuspid and dome isthmus transection
- Participants
- 291 consecutive patients
- Exposure
- Residual gaps vs no gaps within the lesion set; first leg vs second leg dome transection strategy
- Outcome
- Sinus rhythm maintenance
- Follow-up
- 12 months
Methodological detailsconsecutive patients
- Consecutive patients
Main finding
As reported in the abstract
- Sinus rhythm maintenance after 1 procedure
- 70%
- Sinus rhythm maintenance after 1 or 2 procedures
- 94%
- Event-free survival after first procedure lower with residual gaps (log-rank)
- P = .004
Observational data: associations, not effects.
Further findings
Roof lines considered blocked during first procedure
P < 0.001
Delayed dome gaps at second procedure
P = 0.05
Delayed gaps at second procedure (69 patients relapsing despite complete lesion set)
- Delayed gaps found at second procedure
- 94%
- Recurrence of AF with vs without PV gaps (67% vs 34%)
- P = 0.02
- Atrial tachycardias supported by anatomic isthmus gaps
- 60%
Original publication
Gaps after linear ablation of persistent atrial fibrillation (Marshall-PLAN): Clinical implication. Heart Rhythm. Published 14 September 2022. doi:10.
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