Trial reportCirculation. Arrhythmia and electrophysiology2025
Marshall-Plan Ablation Strategy Versus Pulmonary Vein Isolation in Persistent AF: A Randomized Controlled Trial.
Trial report in Circulation. Arrhythmia and electrophysiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04206982 (MARSHALL Bundles Elimination, Pulmonary Veins Isolation and Lines Completion for ANatomical Ablation of Persistent Atrial Fibrillation Versus Pulmonary Veins Isolation), which is not on this map. Cited by 25 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
MARSHALL Bundles Elimination, Pulmonary Veins Isolation and Lines Completion for ANatomical Ablation of Persistent Atrial Fibrillation Versus Pulmonary Veins Isolation: The MARSHALL PLAN Monocentric Trial
Who cites it
25 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Ethanol infusion of the vein of marshall-based strategies for persistent atrial fibrillation: a systematic review and meta-analysis of randomized trials.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Pooled it
- Ethanol Infusion in the Vein of Marshall for Persistent Atrial Fibrillation Ablation: Evidence From Randomized Controlled Trials.Journal of cardiovascular electrophysiology · 2025Pooled it
- Lattice-tip vs. standard irrigated focal-tip catheter for radiofrequency ablation of the cavotricuspid isthmus - the LINEAR randomized trial.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Trial
- Ablation versus drug therapy in atrial fibrillation patients with or without prior Pharmacological or direct current cardioversion: results from the CABANA trial.BMC cardiovascular disorders · 2025Trial
- Vein of Marshall ethanol infusion in persistent atrial fibrillation: Insight from VOMALC-PeAF registry.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026Article
- Algorithm-guided personalized pulsed field ablation for persistent atrial fibrillation: a prospective multicentre study with matched external comparison.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Article
- Ethanol Infusion in the Vein of Marshall as an Adjunct to Catheter Ablation in Persistent Atrial Fibrillation.Pacing and clinical electrophysiology : PACE · 2026Article
- Double-Balloon Versus Selective Vein of Marshall Ethanol Infusion for Mitral Isthmus Block in Atrial Fibrillation.Pacing and clinical electrophysiology : PACE · 2026Review
- Acute Termination of Atrial Fibrillation During Ablation of a Left Atrial Slow-Conduction Channel.Journal of cardiovascular electrophysiology · 2026Article
- Phenotype-Guided Management of Atrial Fibrillation in Heart Failure: From Rate Control to Catheter Ablation.Journal of clinical medicine · 2026Review
- Acute efficacy of a focal dual-energy contact force-sensing catheter vs. standard radiofrequency for anatomical ablation of persistent atrial fibrillation: a pilot study.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Article
- Ethanol Infusion Into the Vein of Marshall for Atrial Fibrillation: Clinical Efficacy and Technical Limitations.Clinical cardiology · 2026Review
- Impact of radiofrequency power settings on acute mitral isthmus ablation success with concomitant vein of Marshall ethanol infusion.Heart rhythm O2 · 2026Article
- Convergent Hybrid Ablation Versus Catheter Ablation in Patients With Persistent Atrial Fibrillation and Heart Failure: HALT AF Study Protocol and Rationale for a Multicenter Randomized Controlled Trial.Journal of the American Heart Association · 2026Article
- Role of interatrial connection ablation in re-entry dynamics: an in silico evaluation.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Article
- Posterior mitral isthmus ablation using a balloon-in-basket pulsed-field multielectrode catheter.HeartRhythm case reports · 2026Article
- Substrate ablation as concomitant treatment for left atrial macroreentrant tachycardia (SLICE-LAMRT): rationale and study design.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026Article
- Epicardial muscle bundles in persistent atrial fibrillation: from overlooked bystanders to arrhythmogenic modulators.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026Review
- The Role of Ethanol Ablation of the Vein of Marshall in the Era of Pulsed Field Ablation.Journal of clinical medicine · 2026Review
- Left atrial anterior scar in persistent atrial fibrillation: Results with pulmonary vein isolation and linear ablation including posterior mitral line.Heart rhythm O2 · 2026Article
Corrections and comments
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Authors and funding
18 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundBeyond pulmonary vein (PV) isolation, the optimal ablation strategy for persistent atrial fibrillation (AF) remains poorly defined. The purpose of this study was to compare 2 ablation strategies in the treatment of patients with persistent AF: a comprehensive ablation strategy based on anatomic considerations versus PV isolation alone.
methodsThe Marshall-Plan trial is a prospective, randomized, parallel-group, controlled clinical trial of superiority conducted at the Bordeaux University Hospital. Consecutive patients with symptomatic, documented persistent AF were included and randomized into 2 arms: Marshall-Plan consisting of PV isolation with additional ablation including vein of Marshall ethanol infusion, and lines of block at the mitral, dome, and cavotricuspid isthmuses versus PV isolation alone. The main outcome was the 1-year freedom from any arrhythmia (atrial fibrillation/atrial tachycardia >30 seconds) after a single ablation procedure with or without any antiarrhythmic medication at 12 months.
resultsA total of 120 patients were included (age 65±8 years; 21 women). Two patients were excluded from analysis. All PVs were successfully isolated in both groups. In the Marshall-Plan group, vein of Marshall ethanol infusion was completed in 57 (97%) patients. Conduction block across linear lesions was obtained in 93%, 92%, and 93% of the mitral, dome, and cavotricuspid isthmuses, respectively. The full lesion set was successfully completed in 52 (88%) patients in the Marshall-Plan group and 59 (100%) patients in the PV isolation group. At 12 months, freedom from recurrence of atrial arrhythmia >30 seconds after 1 ablation procedure, with or without antiarrhythmic medication, had occurred in 51 of the 59 (86.4%) patients assigned to the Marshall-Plan approach, and 39 of the 59 (66.1%) patients assigned to PV isolation only (
conclusionsIn this prospective randomized controlled trial, the Marshall-Plan strategy was significantly superior to a PV isolation strategy at 12 months. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04206982.
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