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Treatment of Recurrent Nonparoxysmal Atrial Fibrillation Using Focal Impulse and Rotor Mapping (FIRM)‐Guided Rotor Ablation: Early Recurrence and Long‐Term Outcomes
Author(s) -
SPITZER STEFAN GEORG,
KÁROLYI LÁSZLÓ,
RÄMMLER CAROLA,
SCHARFE FRANK,
WEINMANN THOMAS,
ZIESCHANK MIRKO,
LANGBEIN ANKE
Publication year - 2017
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.13110
Subject(s) - medicine , ablation , pulmonary vein , atrial fibrillation , catheter ablation , cardiology , propensity score matching , surgery
FIRM Ablation Outcomes for Recurrent Nonparoxysmal AF Introduction A patient‐tailored ablation approach focused on the elimination of both pulmonary vein triggers as well as substrate drivers may result in favorable outcomes in recurrent persistent AF patients. Objective We evaluated the long‐term outcomes of rotor ablation combined with conventional pulmonary vein isolation (PVI) in patients with recurrent nonparoxysmal AF. Methods Fifty‐eight consecutive patients underwent FIRM‐guided rotor ablation followed by conventional PVI for the treatment of recurrent nonparoxysmal AF. A software algorithm was used to display rotational activity at rotor sites by creating propagation maps from unipolar electrograms recorded using a 64‐electrode basket catheter. These rotor sites were targeted for ablation, followed by conventional PVI. Results All patients had nonparoxysmal AF (83% longstanding persistent) and a previously failed conventional ablation procedure. Stable rotors were identified in all patients (mean of 3.0 ± 1.6 per patient), with 55.2% having right atrial rotors and 96.6% left atrial rotors, respectively. Complications occurred in 5.2% of patients, none related to the FIRM procedure. The median follow‐up was 12 months. At 6 and 12 months of follow‐up, 73.2% and 76.9% of patients remained free from AF/AT, respectively. Excluding 2 patients who underwent a successful redo ablation procedure/electrical cardioversion, at 12 months of follow‐up, 69.2% were free from any AF/AT and 73.1% were free from AF after a single FIRM‐guided ablation procedure. Conclusion A high degree of success was observed in this cohort of primarily longstanding persistent AF patients treated for recurrent AF with FIRM‐guided rotor ablation. Prospective randomized controlled trials are needed.