Sanghamitra Mohanty1, Carola Gianni1, Prasant Mohanty1, Philipp Halbfass2, Tamara Metz2, Chintan Trivedi1, Thomas Deneke2, Gery Tomassoni3, Rong Bai4, Amin Al-Ahmad1, Shane Bailey1, John David Burkhardt1, G Joseph Gallinghouse1, Rodney Horton1, Patrick M Hranitzky1, Javier E Sanchez1, Luigi Di Biase5, Andrea Natale6. 1. Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas. 2. Department of Cardiology, Cardiovascular Center, Bad Neustadt, Germany. 3. Department of Cardiology, Lexington Cardiology at Central Baptist, Lexington, Kentucky. 4. Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Department of Electrophysiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. 5. Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Department of Cardiology, Cardiovascular Center, Bad Neustadt, Germany. 6. Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Department of Cardiology, Lexington Cardiology at Central Baptist, Lexington, Kentucky; Department of Electrophysiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Department of Electrophysiology and Arrhythmia Services, California Pacific Medical Center, San Francisco, California; Interventional Electrophysiology, Scripps Clinic, La Jolla, California; Internal Medicine, Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Cardiology, Stanford University, Stanford, California; Department of Internal Medicine, Dell Medical School, University of Texas, Austin, Texas.
Abstract
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. (Outcome of Different Ablation Strategies in Persistent and Long-Standing Persistent Atrial Fibrillation [OASIS]; NCT02533843).
RCT Entities:
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 fibrillationpatients. 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. (Outcome of Different Ablation Strategies in Persistent and Long-Standing Persistent Atrial Fibrillation [OASIS]; NCT02533843).
Authors: Brian J Hansen; Thomas A Csepe; Jichao Zhao; Anthony J Ignozzi; John D Hummel; Vadim V Fedorov Journal: Circ Arrhythm Electrophysiol Date: 2016-10
Authors: Tobias Oesterlein; Daniel Frisch; Axel Loewe; Gunnar Seemann; Claus Schmitt; Olaf Dössel; Armin Luik Journal: Biomed Res Int Date: 2016-12-13 Impact factor: 3.411
Authors: Tiago P Almeida; Gavin S Chu; Xin Li; Nawshin Dastagir; Jiun H Tuan; Peter J Stafford; Fernando S Schlindwein; G André Ng Journal: Front Physiol Date: 2017-08-24 Impact factor: 4.566