Acute and early outcomes of focal impulse and rotor modulation (FIRM)-guided rotors-only ablation in patients with nonparoxysmal atrial fibrillation

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• 作者：Carola Gianni ; MD^* ; ^&dagger ; ; Sanghamitra Mohanty ; MD ; MS ; FHRS^* ; Luigi Di Biase ; MD ; PhD ; FHRS^* ; ^&Dagger ; ; ^§ ; ; ^║ ; Tamara Metz ; RN ; BSN^* ; Chintan Trivedi ; MD^* ; Yalç ; ın Gö ; koğlan ; MD^* ; ^¶ ; ; Mahmut F. Gü ; neş ; MD^* ; Rong Bai ; MD ; FHRS^* ; Amin Al-Ahmad ; MD ; CCDS ; FHRS^* ; J. David Burkhardt ; MD ; FHRS^* ; G. Joseph Gallinghouse ; MD ; FHRS^* ; Rodney P. Horton ; MD ; FHRS^* ; ^§ ; ; Patrick M. Hranitzky ; MD ; FHRS^* ; Javier E. Sanchez ; MD^* ; Phillipp Halbfaß ; MD^# ; Patrick Mü ; ller ; MD^# ; ^** ; Anja Schade ; MD^# ; Thomas Deneke ; MD ; PhD ; FHRS^# ; ^** ; Gery F. Tomassoni ; MD ; FHRS^&dagger ; &dagger ; ; Andrea Natale ; MD ; FHRS^* ; ^&Dagger ; ; ^§ ; ; ^&Dagger ; &Dagger ; ; ^§ ; § ; ; ^║║ ; ^¶ ; ¶ ; ; ^## ; ^{dr.natale@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Atrial fibrillation ; Catheter ablation ; Rotor ; FIRM mapping
• 刊名：Heart Rhythm
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：13
• 期：4
• 页码：830-835
• 全文大小：1096 K

文摘

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.