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February 20, 2023American Heart JournalOpen Access

Prospective randomized comparison between upgraded ‘2C3L’ vs. PVI approach for catheter ablation of persistent atrial fibrillation: PROMPT-AF trial design

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Why the study?

PVI plus linear ablation has failed to improve persistent AF ablation success over PVI alone, largely due to incomplete linear block causing peri-mitral reentry, whereas ethanol infusion into the vein of Marshall facilitates durable mitral isthmus lesions.

Does the upgraded '2C3L' ablation strategy improve freedom from atrial arrhythmias compared to PVI alone in patients undergoing first catheter ablation for persistent atrial fibrillation?

Population

498 patients undergoing first catheter ablation of PeAF

Comparison

Upgraded 2C3L strategy vs PVI alone

Design

Prospective, multicenter, open-label, 1:1 randomized trial

Follow-up

12 months

Authors

XLXiaoxia LiuQLQiang LiuYLYiwei Lai

Discussion

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Overview

Adjunctive EI-VOM should not yet change PeAF ablation practice; leaves open whether it overcomes prior linear-strategy failures.

Structured PICO

Does the upgraded '2C3L' ablation strategy improve freedom from atrial arrhythmias compared to PVI alone in patients undergoing first catheter ablation for persistent atrial fibrillation?

P
Population
498 patients undergoing their first catheter ablation of persistent atrial fibrillation (PeAF)
I
Intervention
Upgraded '2C3L' technique (ethanol infusion into the vein of Marshall [EI-VOM], bilateral circumferential PVI, and 3 linear ablation lesion sets across the mitral isthmus, left atrial roof, and cavotricuspid isthmus)
C
Comparator
Pulmonary vein antral isolation (PVI) alone
O
Outcome
Freedom from atrial arrhythmias of >30 seconds, without antiarrhythmic drugs, in 12 months after the index ablation procedure (excluding a blanking period of 3 months)

This trial design outlines a randomized comparison between an upgraded '2C3L' ablation strategy and PVI alone for patients with persistent atrial fibrillation.

Cite This Study

Liu et al. (2023) studied this question.

synapsesocial.com/papers/6a7eb79cd14c4cd8047987a3https://doi.org/10.1016/j.ahj.2023.01.019
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Effect of Catheter Ablation With Vein of Marshall Ethanol Infusion vs Catheter Ablation Alone on Persistent Atrial Fibrillation2020 · 367 citations
  2. 2MARSHALL bundles elimination, Pulmonary veins isolation and Lines completion for ANatomical ablation of persistent atrial fibrillation: MARSHALL‐PLAN case series2018 · 94 citations
  3. 3Effect of Mitral Isthmus Block on Development of Atrial Tachycardia Following Ablation for Atrial Fibrillation2009 · 75 citations
  4. 4Prospective randomized comparison between a fixed ‘2C3L’ approach vs. stepwise approach for catheter ablation of persistent atrial fibrillation2015 · 139 citations
  5. 5Atrial Tachycardia After Circumferential Pulmonary Vein Ablation of Atrial Fibrillation2007 · 356 citations