Gaps after linear ablation of persistent atrial fibrillation (Marshall-PLAN) : Clinical implication
Copyright © 2022 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved..
BACKGROUND: Beyond pulmonary vein (PV) isolation, anatomic isthmus transection is an adjunctive strategy for persistent atrial fibrillation. Data on the durability of multiple lines of block remain scarce.
OBJECTIVE: The purpose of this study was to evaluate the impact of gaps within such a lesion set.
METHODS: We followed 291 consecutive patients who underwent (1) vein of Marshall ethanol infusion, (2) PV isolation, and (3) mitral, cavotricuspid, and dome isthmus transection. Dome transection relied on 2 distinct strategies over time: a single roof line with touch-ups applied in case of gap demonstrated by conventional maneuvers (first leg), and an alternative floor line if the roof line exhibited a gap during high-density mapping with careful electrogram reannotation (second leg).
RESULTS: Twelve-month sinus rhythm maintenance was 70% after 1 procedure and 94% after 1 or 2 procedures. Event-free survival after the first procedure was lower in case of residual gaps within the lesion set (log-rank, P = .004). Delayed gaps were found in 94% of a second procedure performed in the 69 patients relapsing despite a complete lesion set with PV gaps increasing the risk of recurrence of atrial fibrillation (67% vs 34%; P = .02) and anatomic isthmus gaps supporting a majority of atrial tachycardias (60%). Between the first leg and the second leg, a significant decrease was found in roof lines considered blocked during the first procedure (99% vs 78%; P < .001) and in delayed dome gaps observed during a second procedure (68% vs 43%; P = .05).
CONCLUSION: Gaps are arrhythmogenic and can be reduced by optimized ablation and assessment of lines of block. Closing these gaps improves sinus rhythm maintenance.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:20 |
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| Enthalten in: |
Heart rhythm - 20(2023), 1 vom: 15. Jan., Seite 14-21 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Takagi, Takamitsu [VerfasserIn] |
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| Links: |
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| Themen: |
Atrial fibrillation |
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| Anmerkungen: |
Date Completed 09.01.2023 Date Revised 06.02.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.hrthm.2022.09.009 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM346322693 |
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| 100 | 1 | |a Takagi, Takamitsu |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Gaps after linear ablation of persistent atrial fibrillation (Marshall-PLAN) |b Clinical implication |
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| 500 | |a Date Completed 09.01.2023 | ||
| 500 | |a Date Revised 06.02.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2022 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Beyond pulmonary vein (PV) isolation, anatomic isthmus transection is an adjunctive strategy for persistent atrial fibrillation. Data on the durability of multiple lines of block remain scarce | ||
| 520 | |a OBJECTIVE: The purpose of this study was to evaluate the impact of gaps within such a lesion set | ||
| 520 | |a METHODS: We followed 291 consecutive patients who underwent (1) vein of Marshall ethanol infusion, (2) PV isolation, and (3) mitral, cavotricuspid, and dome isthmus transection. Dome transection relied on 2 distinct strategies over time: a single roof line with touch-ups applied in case of gap demonstrated by conventional maneuvers (first leg), and an alternative floor line if the roof line exhibited a gap during high-density mapping with careful electrogram reannotation (second leg) | ||
| 520 | |a RESULTS: Twelve-month sinus rhythm maintenance was 70% after 1 procedure and 94% after 1 or 2 procedures. Event-free survival after the first procedure was lower in case of residual gaps within the lesion set (log-rank, P = .004). Delayed gaps were found in 94% of a second procedure performed in the 69 patients relapsing despite a complete lesion set with PV gaps increasing the risk of recurrence of atrial fibrillation (67% vs 34%; P = .02) and anatomic isthmus gaps supporting a majority of atrial tachycardias (60%). Between the first leg and the second leg, a significant decrease was found in roof lines considered blocked during the first procedure (99% vs 78%; P < .001) and in delayed dome gaps observed during a second procedure (68% vs 43%; P = .05) | ||
| 520 | |a CONCLUSION: Gaps are arrhythmogenic and can be reduced by optimized ablation and assessment of lines of block. Closing these gaps improves sinus rhythm maintenance | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Atrial fibrillation | |
| 650 | 4 | |a Catheter ablation | |
| 650 | 4 | |a Cavotricuspid isthmus | |
| 650 | 4 | |a Conduction block | |
| 650 | 4 | |a Conduction gap | |
| 650 | 4 | |a Floor line | |
| 650 | 4 | |a Mitral line | |
| 650 | 4 | |a Pulmonary vein isolation | |
| 650 | 4 | |a Roof line | |
| 700 | 1 | |a Derval, Nicolas |e verfasserin |4 aut | |
| 700 | 1 | |a Duchateau, Josselin |e verfasserin |4 aut | |
| 700 | 1 | |a Chauvel, Rémi |e verfasserin |4 aut | |
| 700 | 1 | |a Tixier, Romain |e verfasserin |4 aut | |
| 700 | 1 | |a Marchand, Hugo |e verfasserin |4 aut | |
| 700 | 1 | |a Bouyer, Benjamin |e verfasserin |4 aut | |
| 700 | 1 | |a André, Clémentine |e verfasserin |4 aut | |
| 700 | 1 | |a Kamakura, Tsukasa |e verfasserin |4 aut | |
| 700 | 1 | |a Krisai, Philipp |e verfasserin |4 aut | |
| 700 | 1 | |a Ascione, Ciro |e verfasserin |4 aut | |
| 700 | 1 | |a Balbo, Conrado |e verfasserin |4 aut | |
| 700 | 1 | |a Cheniti, Ghassen |e verfasserin |4 aut | |
| 700 | 1 | |a Denis, Arnaud |e verfasserin |4 aut | |
| 700 | 1 | |a Sacher, Frédéric |e verfasserin |4 aut | |
| 700 | 1 | |a Hocini, Mélèze |e verfasserin |4 aut | |
| 700 | 1 | |a Jaïs, Pierre |e verfasserin |4 aut | |
| 700 | 1 | |a Haïssaguerre, Michel |e verfasserin |4 aut | |
| 700 | 1 | |a Pambrun, Thomas |e verfasserin |4 aut | |
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