BACKGROUND: The utility of rotor ablation using commercially available systems as an adjunct to pulmonary vein isolation (PVI) is controversial. Variable results may stem from heterogeneous practice patterns. We investigated whether a prespecified protocol to determine temperospatial rotor stability improved acute and intermediate outcomes following rotor ablation. HYPOTHESIS: Protocolized rotor mapping and ablation, with prespecified metrics to determine temporal rotor stability prior to ablation, will improve short- and long-term PVI/rotor ablation outcomes. METHODS: Patients undergoing PVI plus rotor ablation at Johns Hopkins during 2015 were included. The first cohort underwent rotor mapping and ablation at the operator's discretion, whereas the second cohort underwent protocolized rotor mapping, with ablation limited to temperospatially stable rotors. Both cohorts underwent PVI. Acute results (rotor elimination, atrial fibrillation [AF] termination), procedural data, and 1-year outcomes were assessed. RESULTS: Twenty-seven patients underwent ablation (mean age, 64.4 ± 9 years, male 81.5%, persistent AF 85.2%, long-standing persistent AF 14.8%, mean AF duration 4.4 ± 4 years, repeat cases 51.8%, and mean LA size 4.6 ± 0.8 cm). In the protocolized cohort, rotors were reproducible in 83% (10/12) of cases in at least 1 chamber. Acute rhythm change was achieved in 8/27 (29.6%) patients. Sinus rhythm on presentation (62.5% vs 15.8%, P = 0.03) and higher total targeted rotors (3.8 ± 1.7 vs 2.5 ± 1.0, P = 0.02) predicted acute change. At 12 months, freedom from AF/atrial tachycardia was achieved in 5/15 (33.3%) patients in the first cohort and 5/11 patients in the protocolized cohort (45.5%; P = 0.53 for comparison). CONCLUSIONS: Acute and intermediate results did not change with protocolized mapping designed to identify temperospatially stable rotors. Outcomes at 12 months were similar in both groups.
BACKGROUND: The utility of rotor ablation using commercially available systems as an adjunct to pulmonary vein isolation (PVI) is controversial. Variable results may stem from heterogeneous practice patterns. We investigated whether a prespecified protocol to determine temperospatial rotor stability improved acute and intermediate outcomes following rotor ablation. HYPOTHESIS: Protocolized rotor mapping and ablation, with prespecified metrics to determine temporal rotor stability prior to ablation, will improve short- and long-term PVI/rotor ablation outcomes. METHODS:Patients undergoing PVI plus rotor ablation at Johns Hopkins during 2015 were included. The first cohort underwent rotor mapping and ablation at the operator's discretion, whereas the second cohort underwent protocolized rotor mapping, with ablation limited to temperospatially stable rotors. Both cohorts underwent PVI. Acute results (rotor elimination, atrial fibrillation [AF] termination), procedural data, and 1-year outcomes were assessed. RESULTS: Twenty-seven patients underwent ablation (mean age, 64.4 ± 9 years, male 81.5%, persistent AF 85.2%, long-standing persistent AF 14.8%, mean AF duration 4.4 ± 4 years, repeat cases 51.8%, and mean LA size 4.6 ± 0.8 cm). In the protocolized cohort, rotors were reproducible in 83% (10/12) of cases in at least 1 chamber. Acute rhythm change was achieved in 8/27 (29.6%) patients. Sinus rhythm on presentation (62.5% vs 15.8%, P = 0.03) and higher total targeted rotors (3.8 ± 1.7 vs 2.5 ± 1.0, P = 0.02) predicted acute change. At 12 months, freedom from AF/atrial tachycardia was achieved in 5/15 (33.3%) patients in the first cohort and 5/11 patients in the protocolized cohort (45.5%; P = 0.53 for comparison). CONCLUSIONS: Acute and intermediate results did not change with protocolized mapping designed to identify temperospatially stable rotors. Outcomes at 12 months were similar in both groups.
Authors: Vijay Swarup; Tina Baykaner; Armand Rostamian; James P Daubert; John Hummel; David E Krummen; Rishi Trikha; John M Miller; Gery F Tomassoni; Sanjiv M Narayan Journal: J Cardiovasc Electrophysiol Date: 2014-11-11
Authors: Sanjiv M Narayan; Tina Baykaner; Paul Clopton; Amir Schricker; Gautam G Lalani; David E Krummen; Kalyanam Shivkumar; John M Miller Journal: J Am Coll Cardiol Date: 2014-03-13 Impact factor: 24.094
Authors: Sanjiv M Narayan; David E Krummen; Kalyanam Shivkumar; Paul Clopton; Wouter-Jan Rappel; John M Miller Journal: J Am Coll Cardiol Date: 2012-07-18 Impact factor: 24.094
Authors: Hugh Calkins; Karl Heinz Kuck; Riccardo Cappato; Josep Brugada; A John Camm; Shih-Ann Chen; Harry J G Crijns; Ralph J Damiano; D Wyn Davies; John DiMarco; James Edgerton; Kenneth Ellenbogen; Michael D Ezekowitz; David E Haines; Michel Haissaguerre; Gerhard Hindricks; Yoshito Iesaka; Warren Jackman; José Jalife; Pierre Jais; Jonathan Kalman; David Keane; Young-Hoon Kim; Paulus Kirchhof; George Klein; Hans Kottkamp; Koichiro Kumagai; Bruce D Lindsay; Moussa Mansour; Francis E Marchlinski; Patrick M McCarthy; J Lluis Mont; Fred Morady; Koonlawee Nademanee; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Douglas L Packer; Carlo Pappone; Eric Prystowsky; Antonio Raviele; Vivek Reddy; Jeremy N Ruskin; Richard J Shemin; Hsuan-Ming Tsao; David Wilber Journal: Heart Rhythm Date: 2012-03-01 Impact factor: 6.343
Authors: Eric Buch; Peyman Benharash; Paul Frank; Michael Share; Roderick Tung; Kalyanam Shivkumar; Ravi Mandapati; Ravi Mandapati Journal: Circ Arrhythm Electrophysiol Date: 2015-10
Authors: Rukshen Weerasooriya; Paul Khairy; Jean Litalien; Laurent Macle; Meleze Hocini; Frederic Sacher; Nicolas Lellouche; Sebastien Knecht; Matthew Wright; Isabelle Nault; Shinsuke Miyazaki; Christophe Scavee; Jacques Clementy; Michel Haissaguerre; Pierre Jais Journal: J Am Coll Cardiol Date: 2011-01-11 Impact factor: 24.094
Authors: Sanjiv M Narayan; David E Krummen; Paul Clopton; Kalyanam Shivkumar; John M Miller Journal: J Am Coll Cardiol Date: 2013-04-03 Impact factor: 24.094
Authors: John M Miller; Robert C Kowal; Vijay Swarup; James P Daubert; Emile G Daoud; John D Day; Kenneth A Ellenbogen; John D Hummel; Tina Baykaner; David E Krummen; Sanjiv M Narayan; Vivek Y Reddy; Kalyanam Shivkumar; Jonathan S Steinberg; Kevin R Wheelan Journal: J Cardiovasc Electrophysiol Date: 2014-07-23
Authors: Daniël A Pijnappels; Antoine A F de Vries; Niels Harlaar; Sven O Dekker; Juan Zhang; Rebecca R Snabel; Marieke W Veldkamp; Arie O Verkerk; Carla Cofiño Fabres; Verena Schwach; Lente J S Lerink; Mathilde R Rivaud; Aat A Mulder; Willem E Corver; Marie José T H Goumans; Dobromir Dobrev; Robert J M Klautz; Martin J Schalij; Gert Jan C Veenstra; Robert Passier; Thomas J van Brakel Journal: Nat Biomed Eng Date: 2022-01-06 Impact factor: 29.234
Authors: Tina Baykaner; Albert J Rogers; Gabriela L Meckler; Junaid Zaman; Rachita Navara; Miguel Rodrigo; Mahmood Alhusseini; Christopher A B Kowalewski; Mohan N Viswanathan; Sanjiv M Narayan; Paul Clopton; Paul J Wang; Paul A Heidenreich Journal: Circ Arrhythm Electrophysiol Date: 2018-05
Authors: Stefan Georg Spitzer; László Károlyi; Carola Rämmler; Frank Scharfe; Mirko Zieschank; Anke Langbein Journal: Herzschrittmacherther Elektrophysiol Date: 2018-08-06
Authors: Patrick M Boyle; Joe B Hakim; Sohail Zahid; William H Franceschi; Michael J Murphy; Adityo Prakosa; Konstantinos N Aronis; Tarek Zghaib; Muhammed Balouch; Esra G Ipek; Jonathan Chrispin; Ronald D Berger; Hiroshi Ashikaga; Joseph E Marine; Hugh Calkins; Saman Nazarian; David D Spragg; Natalia A Trayanova Journal: Front Physiol Date: 2018-08-29 Impact factor: 4.566
Authors: Mahmoud Ehnesh; Xin Li; Tiago P Almeida; Gavin S Chu; Nawshin Dastagir; Peter J Stafford; G André Ng; Fernando S Schlindwein Journal: Front Physiol Date: 2022-08-05 Impact factor: 4.755
Authors: Balvinder S Handa; Caroline H Roney; Charles Houston; Norman A Qureshi; Xinyang Li; David S Pitcher; Rasheda A Chowdhury; Phang Boon Lim; Emmanuel Dupont; Steven A Niederer; Chris D Cantwell; Nicholas S Peters; Fu Siong Ng Journal: Comput Biol Med Date: 2018-07-17 Impact factor: 4.589