Impact of Rotor Ablation in Nonparoxysmal Atrial Fibrillation Patients: Results From the Randomized OASIS Trial

Sanghamitra Mohanty, Carola Gianni, Prasant Mohanty, Philipp Halbfass, Tamara Metz, Chintan Trivedi, Thomas Deneke, Gery Tomassoni, Rong Bai, Amin Al-Ahmad, Shane Bailey, John David Burkhardt, G. Joseph Gallinghouse, Rodney Horton, Patrick M. Hranitzky, Javier E. Sanchez, Luigi Di Biase, Andrea Natale

Research output: Contribution to journalArticle

35 Citations (Scopus)

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)

Original languageEnglish (US)
Pages (from-to)274-282
Number of pages9
JournalJournal of the American College of Cardiology
Volume68
Issue number3
DOIs
StatePublished - Jul 19 2016
Externally publishedYes

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Atrial Fibrillation
Pulmonary Veins
Tachycardia
Medical Futility
poly(divinyl-co-N-vinylpyrrolidinone)
Anti-Arrhythmia Agents

Keywords

  • FIRM-guided ablation
  • non-PV triggers
  • nonparoxysmal AF
  • PVAI
  • rotors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of Rotor Ablation in Nonparoxysmal Atrial Fibrillation Patients : Results From the Randomized OASIS Trial. / Mohanty, Sanghamitra; Gianni, Carola; Mohanty, Prasant; Halbfass, Philipp; Metz, Tamara; Trivedi, Chintan; Deneke, Thomas; Tomassoni, Gery; Bai, Rong; Al-Ahmad, Amin; Bailey, Shane; Burkhardt, John David; Gallinghouse, G. Joseph; Horton, Rodney; Hranitzky, Patrick M.; Sanchez, Javier E.; Di Biase, Luigi; Natale, Andrea.

In: Journal of the American College of Cardiology, Vol. 68, No. 3, 19.07.2016, p. 274-282.

Research output: Contribution to journalArticle

Mohanty, S, Gianni, C, Mohanty, P, Halbfass, P, Metz, T, Trivedi, C, Deneke, T, Tomassoni, G, Bai, R, Al-Ahmad, A, Bailey, S, Burkhardt, JD, Gallinghouse, GJ, Horton, R, Hranitzky, PM, Sanchez, JE, Di Biase, L & Natale, A 2016, 'Impact of Rotor Ablation in Nonparoxysmal Atrial Fibrillation Patients: Results From the Randomized OASIS Trial', Journal of the American College of Cardiology, vol. 68, no. 3, pp. 274-282. https://doi.org/10.1016/j.jacc.2016.04.015
Mohanty, Sanghamitra ; Gianni, Carola ; Mohanty, Prasant ; Halbfass, Philipp ; Metz, Tamara ; Trivedi, Chintan ; Deneke, Thomas ; Tomassoni, Gery ; Bai, Rong ; Al-Ahmad, Amin ; Bailey, Shane ; Burkhardt, John David ; Gallinghouse, G. Joseph ; Horton, Rodney ; Hranitzky, Patrick M. ; Sanchez, Javier E. ; Di Biase, Luigi ; Natale, Andrea. / Impact of Rotor Ablation in Nonparoxysmal Atrial Fibrillation Patients : Results From the Randomized OASIS Trial. In: Journal of the American College of Cardiology. 2016 ; Vol. 68, No. 3. pp. 274-282.
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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)",
keywords = "FIRM-guided ablation, non-PV triggers, nonparoxysmal AF, PVAI, rotors",
author = "Sanghamitra Mohanty and Carola Gianni and Prasant Mohanty and Philipp Halbfass and Tamara Metz and Chintan Trivedi and Thomas Deneke and Gery Tomassoni and Rong Bai and Amin Al-Ahmad and Shane Bailey and Burkhardt, {John David} and Gallinghouse, {G. Joseph} and Rodney Horton and Hranitzky, {Patrick M.} and Sanchez, {Javier E.} and {Di Biase}, Luigi and Andrea Natale",
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T1 - Impact of Rotor Ablation in Nonparoxysmal Atrial Fibrillation Patients

T2 - Results From the Randomized OASIS Trial

AU - Mohanty, Sanghamitra

AU - Gianni, Carola

AU - Mohanty, Prasant

AU - Halbfass, Philipp

AU - Metz, Tamara

AU - Trivedi, Chintan

AU - Deneke, Thomas

AU - Tomassoni, Gery

AU - Bai, Rong

AU - Al-Ahmad, Amin

AU - Bailey, Shane

AU - Burkhardt, John David

AU - Gallinghouse, G. Joseph

AU - Horton, Rodney

AU - Hranitzky, Patrick M.

AU - Sanchez, Javier E.

AU - Di Biase, Luigi

AU - Natale, Andrea

PY - 2016/7/19

Y1 - 2016/7/19

N2 - 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)

AB - 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)

KW - FIRM-guided ablation

KW - non-PV triggers

KW - nonparoxysmal AF

KW - PVAI

KW - rotors

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