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

作者：Gianni Carola; Mohanty Sanghamitra; Di Biase Luigi; Metz Tamara; Trivedi Chintan; Goekoglan Yalcin; Guenes Mahmut F; Bai Rong; Al Ahmad Amin; Burkhardt J David; Gallinghouse G Joseph; Horton Rodney P; Hranitzky Patrick M; Sanchez Javier E; Halbfass Phillipp; Mueller Patrick; Schade Anja; Deneke Thomas; Tomassoni Gery F; Natale Andrea

来源：Heart Rhythm, 2016, 13(4): 830-835.

DOI：10.1016/j.hrthm.2015.12.028

• Atrial fibrillation
• Catheter ablation
• Rotor
• FIRM mapping

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.

• 出版日期2016-4
• 单位中国人民解放军军事医学科学院