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

Carola Gianni, Sanghamitra Mohanty, Luigi Di Biase, Tamara Metz, Chintan Trivedi, Yalçin Gökoǧlan, Mahmut F. Güneş, Rong Bai, Amin Al-Ahmad, J. David Burkhardt, G. Joseph Gallinghouse, Rodney P. Horton, Patrick M. Hranitzky, Javier E. Sanchez, Phillipp Halbfaß, Patrick Müller, Anja Schade, Thomas Deneke, Gery F. Tomassoni, Andrea Natale

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

Background 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.

Original languageEnglish (US)
Pages (from-to)830-835
Number of pages6
JournalHeart Rhythm
Volume13
Issue number4
DOIs
StatePublished - Apr 1 2016

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Atrial Fibrillation
Tachycardia
Organizations
Anti-Arrhythmia Agents
Safety
Recurrence

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • FIRM mapping
  • Rotor

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Acute and early outcomes of focal impulse and rotor modulation (FIRM)-guided rotors-only ablation in patients with nonparoxysmal atrial fibrillation. / Gianni, Carola; Mohanty, Sanghamitra; Di Biase, Luigi; Metz, Tamara; Trivedi, Chintan; Gökoǧlan, Yalçin; Güneş, Mahmut F.; Bai, Rong; Al-Ahmad, Amin; David Burkhardt, J.; Joseph Gallinghouse, G.; Horton, Rodney P.; Hranitzky, Patrick M.; Sanchez, Javier E.; Halbfaß, Phillipp; Müller, Patrick; Schade, Anja; Deneke, Thomas; Tomassoni, Gery F.; Natale, Andrea.

In: Heart Rhythm, Vol. 13, No. 4, 01.04.2016, p. 830-835.

Research output: Contribution to journalArticle

Gianni, C, Mohanty, S, Di Biase, L, Metz, T, Trivedi, C, Gökoǧlan, Y, Güneş, MF, Bai, R, Al-Ahmad, A, David Burkhardt, J, Joseph Gallinghouse, G, Horton, RP, Hranitzky, PM, Sanchez, JE, Halbfaß, P, Müller, P, Schade, A, Deneke, T, Tomassoni, GF & Natale, A 2016, 'Acute and early outcomes of focal impulse and rotor modulation (FIRM)-guided rotors-only ablation in patients with nonparoxysmal atrial fibrillation', Heart Rhythm, vol. 13, no. 4, pp. 830-835. https://doi.org/10.1016/j.hrthm.2015.12.028
Gianni, Carola ; Mohanty, Sanghamitra ; Di Biase, Luigi ; Metz, Tamara ; Trivedi, Chintan ; Gökoǧlan, Yalçin ; Güneş, Mahmut F. ; Bai, Rong ; Al-Ahmad, Amin ; David Burkhardt, J. ; Joseph Gallinghouse, G. ; Horton, Rodney P. ; Hranitzky, Patrick M. ; Sanchez, Javier E. ; Halbfaß, Phillipp ; Müller, Patrick ; Schade, Anja ; Deneke, Thomas ; Tomassoni, Gery F. ; Natale, Andrea. / Acute and early outcomes of focal impulse and rotor modulation (FIRM)-guided rotors-only ablation in patients with nonparoxysmal atrial fibrillation. In: Heart Rhythm. 2016 ; Vol. 13, No. 4. pp. 830-835.
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abstract = "Background 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.",
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T1 - Acute and early outcomes of focal impulse and rotor modulation (FIRM)-guided rotors-only ablation in patients with nonparoxysmal atrial fibrillation

AU - Gianni, Carola

AU - Mohanty, Sanghamitra

AU - Di Biase, Luigi

AU - Metz, Tamara

AU - Trivedi, Chintan

AU - Gökoǧlan, Yalçin

AU - Güneş, Mahmut F.

AU - Bai, Rong

AU - Al-Ahmad, Amin

AU - David Burkhardt, J.

AU - Joseph Gallinghouse, G.

AU - Horton, Rodney P.

AU - Hranitzky, Patrick M.

AU - Sanchez, Javier E.

AU - Halbfaß, Phillipp

AU - Müller, Patrick

AU - Schade, Anja

AU - Deneke, Thomas

AU - Tomassoni, Gery F.

AU - Natale, Andrea

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Background 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.

AB - Background 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.

KW - Atrial fibrillation

KW - Catheter ablation

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