Arrhythmias & electrophysiology
Sequential vs First-Intention Marshall-PLAN Strategy in Persistent Atrial Fibrillation Ablation: A Propensity Score Analysis
Authors' conclusion
In PsAF, a sequential Marshall-PLAN procedure after prior PVI provides similar arrhythmia control to a first-intention Marshall-PLAN strategy. The completeness of the Marshall-PLAN, rather than its timing, seems to be a determinant of durable sinus rhythm maintenance.
Study context
- Population
- Patients treated for persistent atrial fibrillation (PsAF) between September 2022 and April 2025patients treated for PsAF · first-intention Marshall-PLAN 168 · Marshall-PLAN after previous pulmonary vein isolation (PVI) 69
- Participants
- 237 patients
- Exposure
- first-intention group vs sequential group
- first-intention groupn = 168
- sequential groupn = 69
- Outcome
- Arrhythmia recurrence lasting ≥30 seconds (arrhythmia-free survival)
- Follow-up
- 12 months
Methodological detailsinverse probability of treatment weighting from a logistic regression-based propensity score
- Inverse probability of treatment weighting from a logistic regression-based propensity score
Main finding
As reported in the abstract
Observational data: associations, not effects.
Further findings
Predictors of arrhythmia recurrence
| Comparison | HR (95% CI) | P value | |
|---|---|---|---|
| Incomplete Marshall-PLAN · independently associated with arrhythmia recurrence | 5.55 (2.06–14.97) | P = 0.001 | |
| Sequential strategy · not independently associated | 0.52 (0.15–1.83) | P = 0.30 | |
| 0.050.21520Hazard ratio (log scale) |
AF history duration
| Outcome | HR (per mL) | P value |
|---|---|---|
| Predictors of arrhythmia recurrence — Left atrial volume · predictor of AF/atrial tachycardia recurrence | 1.01 | P = 0.015 |
- AF history duration: P = 0.001
Procedural success
- Et-VOM successful
- 92.8%
- Complete Marshall-PLAN set obtained
- 90.4%
Original publication
Sequential vs First-Intention Marshall-PLAN Strategy in Persistent Atrial Fibrillation Ablation: A Propensity Score Analysis. JACC Clin Electrophysiol. Published 11 June 2026. doi:10.
Summarised from the published abstract; every number is checked against it