TY - JOUR
T1 - Impact of Rotor Ablation in Nonparoxysmal Atrial Fibrillation Patients
T2 - Results From the Randomized OASIS Trial
AU - Mohanty, Sanghamitra
AU - Gianni, Carola
AU - Mohanty, Prasant
AU - Halbfass, Philipp
AU - Metz, Tamara
AU - Trivedi, Chintan
AU - Deneke, Thomas
AU - Tomassoni, Gery
AU - Bai, Rong
AU - Al-Ahmad, Amin
AU - Bailey, Shane
AU - Burkhardt, John David
AU - Gallinghouse, G. Joseph
AU - Horton, Rodney
AU - Hranitzky, Patrick M.
AU - Sanchez, Javier E.
AU - Di Biase, Luigi
AU - Natale, Andrea
N1 - Publisher Copyright:
© 2016 American College of Cardiology Foundation
PY - 2016/7/19
Y1 - 2016/7/19
N2 - Background Nonrandomized studies have reported focal impulse and rotor modulation (FIRM)-guided ablation to be superior to pulmonary vein antrum isolation (PVAI) for persistent atrial fibrillation and long-standing persistent atrial fibrillation. Objectives This study sought to compare efficacy of FIRM ablation with or without PVAI versus PVAI plus non-PV trigger ablation in randomized persistent atrial fibrillation and long-standing persistent atrial fibrillation patients. Methods Nonparoxysmal atrial fibrillation (AF) patients undergoing first ablation were randomized to FIRM only (group 1), FIRM + PVAI (group 2) or PVAI + posterior wall + non-PV trigger ablation (group 3). Primary endpoint was freedom from atrial tachycardia/AF. The secondary endpoint was acute procedural success, defined as AF termination, ≥10% slowing, or organization into atrial tachycardia. Results A total of 113 patients were enrolled at 3 centers; 29 in group 1 and 42 each in groups 2 and 3. Group 1 enrollment was terminated early for futility. Focal drivers or rotors were detected in all group 1 and 2 patients. Procedure time was significantly shorter in group 3 versus groups 1 and 2 (p < 0.001). In groups 1 and 2, acute success after rotor-only ablation was achieved in 12 patients (41%) and 11 (26%), respectively. After 12 ± 7 months’ follow-up, 4 patients (14%), 22 (52.4%), and 32 (76%) in groups 1, 2, and 3, respectively, were AF/atrial tachycardia–free while off antiarrhythmic drugs (log-rank p < 0.0001). Group 3 patients experienced higher success compared with groups 1 (p < 0.001) and 2 (p = 0.02). Conclusions Outcomes were poor with rotor-only ablation. PVAI + rotor ablation had significantly longer procedure time and lower efficacy than PVAI + posterior wall + non-PV trigger-ablation.
AB - Background Nonrandomized studies have reported focal impulse and rotor modulation (FIRM)-guided ablation to be superior to pulmonary vein antrum isolation (PVAI) for persistent atrial fibrillation and long-standing persistent atrial fibrillation. Objectives This study sought to compare efficacy of FIRM ablation with or without PVAI versus PVAI plus non-PV trigger ablation in randomized persistent atrial fibrillation and long-standing persistent atrial fibrillation patients. Methods Nonparoxysmal atrial fibrillation (AF) patients undergoing first ablation were randomized to FIRM only (group 1), FIRM + PVAI (group 2) or PVAI + posterior wall + non-PV trigger ablation (group 3). Primary endpoint was freedom from atrial tachycardia/AF. The secondary endpoint was acute procedural success, defined as AF termination, ≥10% slowing, or organization into atrial tachycardia. Results A total of 113 patients were enrolled at 3 centers; 29 in group 1 and 42 each in groups 2 and 3. Group 1 enrollment was terminated early for futility. Focal drivers or rotors were detected in all group 1 and 2 patients. Procedure time was significantly shorter in group 3 versus groups 1 and 2 (p < 0.001). In groups 1 and 2, acute success after rotor-only ablation was achieved in 12 patients (41%) and 11 (26%), respectively. After 12 ± 7 months’ follow-up, 4 patients (14%), 22 (52.4%), and 32 (76%) in groups 1, 2, and 3, respectively, were AF/atrial tachycardia–free while off antiarrhythmic drugs (log-rank p < 0.0001). Group 3 patients experienced higher success compared with groups 1 (p < 0.001) and 2 (p = 0.02). Conclusions Outcomes were poor with rotor-only ablation. PVAI + rotor ablation had significantly longer procedure time and lower efficacy than PVAI + posterior wall + non-PV trigger-ablation.
KW - FIRM-guided ablation
KW - PVAI
KW - non-PV triggers
KW - nonparoxysmal AF
KW - rotors
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U2 - 10.1016/j.jacc.2016.04.015
DO - 10.1016/j.jacc.2016.04.015
M3 - Article
C2 - 27163758
AN - SCOPUS:84979895351
SN - 0735-1097
VL - 68
SP - 274
EP - 282
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 3
ER -