TY - JOUR
T1 - Acute and early outcomes of focal impulse and rotor modulation (FIRM)-guided rotors-only ablation in patients with nonparoxysmal atrial fibrillation
AU - Gianni, Carola
AU - Mohanty, Sanghamitra
AU - Di Biase, Luigi
AU - Metz, Tamara
AU - Trivedi, Chintan
AU - Gökoǧlan, Yalçin
AU - Güneş, Mahmut F.
AU - Bai, Rong
AU - Al-Ahmad, Amin
AU - David Burkhardt, J.
AU - Joseph Gallinghouse, G.
AU - Horton, Rodney P.
AU - Hranitzky, Patrick M.
AU - Sanchez, Javier E.
AU - Halbfaß, Phillipp
AU - Müller, Patrick
AU - Schade, Anja
AU - Deneke, Thomas
AU - Tomassoni, Gery F.
AU - Natale, Andrea
N1 - Publisher Copyright:
© 2016 Heart Rhythm Society.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Background Focal impulse and rotor modulation (FIRM)-guided ablation targets sites that are thought to sustain atrial fibrillation (AF). Objective The purpose of this study was to evaluate the acute and mid-term outcomes of FIRM-guided only ablation in patients with nonparoxysmal AF. Methods We prospectively enrolled patients with persistent and long-standing persistent (LSP) AF at three centers to undergo FIRM-guided only ablation. We evaluated acute procedural success (defined as AF termination, organization, or ≥10% slowing), safety (incidence of periprocedural complications), and long-term success (single-procedure freedom from atrial tachycardia [AT]/AF off antiarrhythmic drugs [AAD] after a 2-month blanking period). Results Twenty-nine patients with persistent (N = 20) and LSP (N = 9) AF underwent FIRM mapping. Rotors were presents in all patients, with a mean of 4 ± 1.2 per patient (62% were left atrial); 1 focal impulse was identified. All sources were successfully ablated, and overall acute success rate was 41% (0 AF termination, 2 AF slowing, 10 AF organization). There were no major procedure-related adverse events. After a mean 5.7 months of follow-up, single-procedure freedom from AT/AF without AADs was 17%. Conclusion In nonparoxysmal AF patients, targeted ablation of FIRM-identified rotors is not effective in obtaining AF termination, organization, or slowing during the procedure. After mid-term follow-up, the strategy of ablating FIRM-identified rotors alone did not prevent recurrence from AT/AF.
AB - Background Focal impulse and rotor modulation (FIRM)-guided ablation targets sites that are thought to sustain atrial fibrillation (AF). Objective The purpose of this study was to evaluate the acute and mid-term outcomes of FIRM-guided only ablation in patients with nonparoxysmal AF. Methods We prospectively enrolled patients with persistent and long-standing persistent (LSP) AF at three centers to undergo FIRM-guided only ablation. We evaluated acute procedural success (defined as AF termination, organization, or ≥10% slowing), safety (incidence of periprocedural complications), and long-term success (single-procedure freedom from atrial tachycardia [AT]/AF off antiarrhythmic drugs [AAD] after a 2-month blanking period). Results Twenty-nine patients with persistent (N = 20) and LSP (N = 9) AF underwent FIRM mapping. Rotors were presents in all patients, with a mean of 4 ± 1.2 per patient (62% were left atrial); 1 focal impulse was identified. All sources were successfully ablated, and overall acute success rate was 41% (0 AF termination, 2 AF slowing, 10 AF organization). There were no major procedure-related adverse events. After a mean 5.7 months of follow-up, single-procedure freedom from AT/AF without AADs was 17%. Conclusion In nonparoxysmal AF patients, targeted ablation of FIRM-identified rotors is not effective in obtaining AF termination, organization, or slowing during the procedure. After mid-term follow-up, the strategy of ablating FIRM-identified rotors alone did not prevent recurrence from AT/AF.
KW - Atrial fibrillation
KW - Catheter ablation
KW - FIRM mapping
KW - Rotor
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U2 - 10.1016/j.hrthm.2015.12.028
DO - 10.1016/j.hrthm.2015.12.028
M3 - Article
C2 - 26706193
AN - SCOPUS:84964576058
SN - 1547-5271
VL - 13
SP - 830
EP - 835
JO - Heart Rhythm
JF - Heart Rhythm
IS - 4
ER -