B-PO02-118 LEFT ATRIAL FUNCTION AFTER SUCCESSFUL ABLATION FOR PERSISTENT ATRIAL FIBRILLATION USING THE MARSHALL-PLAN STRATEGY

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Restoring sinus rhythm in patients with persistent atrial fibrillation (PsAF) is expected to yield greater benefits when associated with restoration of left atrial (LA) function. We have previously shown that extensive LA substrate ablation can restore sinus rhythm but is associated with impairments in LA function. The Marshall-PLAN ablation strategy involves pulmonary vein isolation, three linear lesions (LA roof, mitral isthmus, and cavotricuspid isthmus), and ethanol infusion into the vein of Marshall. By design, this strategy avoids disrupting key LA structures in an effort to preserve LA function, using lesion set completion as its procedural endpoint. To examine LA functional parameters after successful ablation for PsAF using the Marshall-PLAN. All patients who underwent index catheter ablation for PsAF using the Marshall-PLAN ablation strategy over 20 months without recurrent AF/atrial tachycardia after a 90-day blanking period were included. Transthoracic echocardiograms performed 6 months post-ablation were analyzed to measure phasic LA volumes as well as transmitral flow and tissue Doppler parameters. All parameters were examined as continuous variables and dichotomized as normal and abnormal based on reference values. 101/110 patients (91.8%) had echocardiographic data available for review (age 64 years [IQR 58-69], 82% male, left ventricular ejection fraction 59% [53-64], follow-up without recurrent arrhythmia 12 months [11-14]). The group’s median indexed LA volume was 40 [34-46] mL/m2 with a peak A wave velocity of 55 [47-64] cm/s. Grade II or III left ventricular diastolic dysfunction was apparent in 12%. Among 58 patients with measurable phasic volumes, median LA total emptying, passive emptying, and active emptying fractions were 39% [28-50], 19% [12-27], and 24% [17-30], respectively. Among patients who have undergone successful catheter ablation for PsAF using the Marshall-PLAN strategy, approximately a quarter have evidence of normal LA reservoir function, nearly half of normal LA conduit function, and a third of normal LA pump function at 6 months. The relative impact of ablation strategies for PsAF on LA function warrant further investigation.