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Gaps after linear ablation of persistent atrial fibrillation (Marshall-PLAN): Clinical implication

dc.rights.licenseopenen_US
dc.contributor.authorTAKAGI, Takamitsu
dc.contributor.authorDERVAL, Nicolas
dc.contributor.authorDUCHATEAU, Josselin
dc.contributor.authorCHAUVEL, Remi
dc.contributor.authorTIXIER, Romain
dc.contributor.authorMARCHAND, Hugo
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorBOUYER, Benjamin
dc.contributor.authorANDRE, Clementine
dc.contributor.authorKAMAKURA, Tsukasa
dc.contributor.authorKRISAI, Philipp
dc.contributor.authorASCIONE, Ciro
dc.contributor.authorBALBO, Conrado
dc.contributor.authorCHENITI, Ghassen
dc.contributor.authorDENIS, Arnaud
dc.contributor.authorSACHER, Frederic
dc.contributor.authorHOCINI, Meleze
dc.contributor.authorJAIS, Pierre
dc.contributor.authorHAISSAGUERRE, Michel
dc.contributor.authorPAMBRUN, Thomas
dc.date.accessioned2023-03-20T09:59:13Z
dc.date.available2023-03-20T09:59:13Z
dc.date.issued2023-01
dc.identifier.issn1556-3871 (Electronic) 1547-5271 (Linking)en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/172372
dc.description.abstractEnBACKGROUND 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 transec-tion relied on 2 distinct strategies over time: a single roof line with touch-ups applied in case of gap demonstrated by conventional ma-neuvers (first leg), and an alternative floor line if the roof line ex-hibited 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 af-ter 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.
dc.language.isoENen_US
dc.subject.enAtrial fibrillation
dc.subject.enCatheter ablation
dc.subject.enConduction block
dc.subject.enConduction gap
dc.subject.enPulmonary vein isolation
dc.subject.enMitral line
dc.subject.enCavotricuspid isthmus
dc.subject.enRoof line
dc.subject.enFloor line
dc.title.enGaps after linear ablation of persistent atrial fibrillation (Marshall-PLAN): Clinical implication
dc.title.alternativeHeart Rhythmen_US
dc.typeArticle de revueen_US
dc.identifier.doi10.1016/j.hrthm.2022.09.009en_US
dc.subject.halSciences du Vivant [q-bio]/Santé publique et épidémiologieen_US
dc.identifier.pubmed36115541en_US
bordeaux.journalHeart Rhythmen_US
bordeaux.page14-21en_US
bordeaux.volume20en_US
bordeaux.hal.laboratoriesBordeaux Population Health Research Center (BPH) - UMR 1219en_US
bordeaux.issue1en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.institutionINSERMen_US
bordeaux.teamAHEAD_BPHen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
hal.identifierhal-04037127
hal.version1
hal.date.transferred2023-03-20T09:59:21Z
hal.exporttrue
dc.rights.ccPas de Licence CCen_US
bordeaux.COinSctx_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.jtitle=Heart%20Rhythm&rft.date=2023-01&rft.volume=20&rft.issue=1&rft.spage=14-21&rft.epage=14-21&rft.eissn=1556-3871%20(Electronic)%201547-5271%20(Linking)&rft.issn=1556-3871%20(Electronic)%201547-5271%20(Linking)&rft.au=TAKAGI,%20Takamitsu&DERVAL,%20Nicolas&DUCHATEAU,%20Josselin&CHAUVEL,%20Remi&TIXIER,%20Romain&rft.genre=article


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