BACKGROUND: There remains controversy about the optimal ablation technique and termination rate of atrial fibrillation (AF) during catheter ablation in patients with persistent AF. The aim of this study was to determine the rate and timing of AF termination during combined pulmonary vein isolation (PVI) and focal impulse and rotor modulation (FIRM)-guided ablation of rotational activity (RoAc). METHODS: This single-center, prospective cohort study enrolled 38 consecutive patients (63% male, mean age 63 ± 11 years) with persistent AF (mean left atrial size: 46 ± 7 mm), who underwent FIRM mapping and ablation of the identified RoAcs followed by PVI. We systematically evaluated the incidence and timing of AF termination during AF ablation. RESULTS: "Late-onset termination" of AF could be observed in 12 (32%) patients after ablation of the identified RoAcs. In a further 10 (26%) patients, "abrupt" AF termination during PVI was achieved. In total, the combined technique of conventional PVI and RoAc ablation resulted in AF termination rate of 58%. ECV was performed in 16 "nonterminating" patients. At 1-year follow-up, 76.1% (16 of 21) of patients remained free from AF/AT, 4 of 10 patients (25%) within the "abruptly" terminated group, 7 of 12 (58.3%) patients among the "late-terminated" group, and 5 of 16 (31, 25%) patients in the "nonterminating" group. CONCLUSION: Large area RoAc ablation combined with PVI results in a moderate termination rate of persistent AF with two distinctive timing patterns. More studies are needed to determine the clinical significance of type of AF termination and long-term success rate of RoAc ablation in patients with persistent AF.
BACKGROUND: There remains controversy about the optimal ablation technique and termination rate of atrial fibrillation (AF) during catheter ablation in patients with persistent AF. The aim of this study was to determine the rate and timing of AF termination during combined pulmonary vein isolation (PVI) and focal impulse and rotor modulation (FIRM)-guided ablation of rotational activity (RoAc). METHODS: This single-center, prospective cohort study enrolled 38 consecutive patients (63% male, mean age 63 ± 11 years) with persistent AF (mean left atrial size: 46 ± 7 mm), who underwent FIRM mapping and ablation of the identified RoAcs followed by PVI. We systematically evaluated the incidence and timing of AF termination during AF ablation. RESULTS: "Late-onset termination" of AF could be observed in 12 (32%) patients after ablation of the identified RoAcs. In a further 10 (26%) patients, "abrupt" AF termination during PVI was achieved. In total, the combined technique of conventional PVI and RoAc ablation resulted in AF termination rate of 58%. ECV was performed in 16 "nonterminating" patients. At 1-year follow-up, 76.1% (16 of 21) of patients remained free from AF/AT, 4 of 10 patients (25%) within the "abruptly" terminated group, 7 of 12 (58.3%) patients among the "late-terminated" group, and 5 of 16 (31, 25%) patients in the "nonterminating" group. CONCLUSION: Large area RoAc ablation combined with PVI results in a moderate termination rate of persistent AF with two distinctive timing patterns. More studies are needed to determine the clinical significance of type of AF termination and long-term success rate of RoAc ablation in patients with persistent AF.
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: Rachita Navara; George Leef; Fatemah Shenasa; Christopher Kowalewski; Albert J Rogers; Gabriela Meckler; Junaid A B Zaman; Tina Baykaner; Shirley Park; Mintu P Turakhia; Paul Zei; Mohan Viswanathan; Paul J Wang; Sanjiv M Narayan Journal: J Cardiovasc Electrophysiol Date: 2018-02-22