Ablation of Rotor and Focal Sources Reduces Late Recurrence of Atrial Fibrillation Compared With Trigger Ablation Alone: Extended Follow-Up of the CONFIRM Trial (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation)
The aim of this study was to determine if ablation that targets patient-specific atrial fibrillation (AF)-sustaining substrates (rotors or focal sources) is more durable than trigger ablation alone at preventing late AF recurrence. Late recurrence substantially limits the efficacy of pulmonary vein...
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| Veröffentlicht in: | Journal of the American College of Cardiology 2014-05, Vol.63 (17), p.1761-1768 |
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| creator | NARAYAN, Sanjiv M BAYKANER, Tina CLOPTON, Paul SCHRICKER, Amir LALANI, Gautam G KRUMMEN, David E SHIVKUMAR, Kalyanam MILLER, John M |
| description | The aim of this study was to determine if ablation that targets patient-specific atrial fibrillation (AF)-sustaining substrates (rotors or focal sources) is more durable than trigger ablation alone at preventing late AF recurrence.
Late recurrence substantially limits the efficacy of pulmonary vein isolation for AF and is associated with pulmonary vein reconnection and the emergence of new triggers.
Three-year follow-up was performed of the CONFIRM (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation) trial, in which 92 consecutive patients with AF (70.7% persistent) underwent novel computational mapping. Ablation comprised source (focal impulse and rotor modulation [FIRM]) and then conventional ablation in 27 patients (FIRM guided) and conventional ablation alone in 65 patients (FIRM blinded). Patients were followed with implanted electrocardiographic monitors when possible (85.2% of FIRM-guided patients, 23.1% of FIRM-blinded patients).
FIRM mapping revealed a median of 2 (interquartile range: 1 to 2) rotors or focal sources in 97.7% of patients during AF. During a median follow-up period of 890 days (interquartile range: 224 to 1,563 days), compared to FIRM-blinded therapy, patients receiving FIRM-guided ablation maintained higher freedom from AF after 1.2 ± 0.4 procedures (median 1; interquartile range: 1 to 1) (77.8% vs. 38.5%, p = 0.001) and a single procedure (p < 0.001) and higher freedom from all atrial arrhythmias (p = 0.003). Freedom from AF was higher when ablation directly or coincidentally passed through sources than when it missed sources (p < 0.001).
FIRM-guided ablation is more durable than conventional trigger-based ablation in preventing 3-year AF recurrence. Future studies should investigate how ablation of patient-specific AF-sustaining rotors and focal sources alters the natural history of arrhythmia recurrence. (The Dynamics of Human Atrial Fibrillation; NCT01008722). |
| doi_str_mv | 10.1016/j.jacc.2014.02.543 |
| format | Article |
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Late recurrence substantially limits the efficacy of pulmonary vein isolation for AF and is associated with pulmonary vein reconnection and the emergence of new triggers.
Three-year follow-up was performed of the CONFIRM (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation) trial, in which 92 consecutive patients with AF (70.7% persistent) underwent novel computational mapping. Ablation comprised source (focal impulse and rotor modulation [FIRM]) and then conventional ablation in 27 patients (FIRM guided) and conventional ablation alone in 65 patients (FIRM blinded). Patients were followed with implanted electrocardiographic monitors when possible (85.2% of FIRM-guided patients, 23.1% of FIRM-blinded patients).
FIRM mapping revealed a median of 2 (interquartile range: 1 to 2) rotors or focal sources in 97.7% of patients during AF. During a median follow-up period of 890 days (interquartile range: 224 to 1,563 days), compared to FIRM-blinded therapy, patients receiving FIRM-guided ablation maintained higher freedom from AF after 1.2 ± 0.4 procedures (median 1; interquartile range: 1 to 1) (77.8% vs. 38.5%, p = 0.001) and a single procedure (p < 0.001) and higher freedom from all atrial arrhythmias (p = 0.003). Freedom from AF was higher when ablation directly or coincidentally passed through sources than when it missed sources (p < 0.001).
FIRM-guided ablation is more durable than conventional trigger-based ablation in preventing 3-year AF recurrence. Future studies should investigate how ablation of patient-specific AF-sustaining rotors and focal sources alters the natural history of arrhythmia recurrence. (The Dynamics of Human Atrial Fibrillation; NCT01008722).</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2014.02.543</identifier><identifier>PMID: 24632280</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier</publisher><subject>Atrial Fibrillation - physiopathology ; Atrial Fibrillation - surgery ; Biological and medical sciences ; Cardiac dysrhythmias ; Cardiology. Vascular system ; Catheter Ablation - methods ; Electrocardiography ; Female ; Follow-Up Studies ; Heart ; Heart Conduction System - physiopathology ; Heart Conduction System - surgery ; Humans ; Male ; Medical sciences ; Middle Aged ; Prospective Studies ; Pulmonary Veins - surgery ; Secondary Prevention ; Time Factors ; Treatment Outcome</subject><ispartof>Journal of the American College of Cardiology, 2014-05, Vol.63 (17), p.1761-1768</ispartof><rights>2015 INIST-CNRS</rights><rights>Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28472083$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24632280$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>NARAYAN, Sanjiv M</creatorcontrib><creatorcontrib>BAYKANER, Tina</creatorcontrib><creatorcontrib>CLOPTON, Paul</creatorcontrib><creatorcontrib>SCHRICKER, Amir</creatorcontrib><creatorcontrib>LALANI, Gautam G</creatorcontrib><creatorcontrib>KRUMMEN, David E</creatorcontrib><creatorcontrib>SHIVKUMAR, Kalyanam</creatorcontrib><creatorcontrib>MILLER, John M</creatorcontrib><title>Ablation of Rotor and Focal Sources Reduces Late Recurrence of Atrial Fibrillation Compared With Trigger Ablation Alone: Extended Follow-Up of the CONFIRM Trial (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation)</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>The aim of this study was to determine if ablation that targets patient-specific atrial fibrillation (AF)-sustaining substrates (rotors or focal sources) is more durable than trigger ablation alone at preventing late AF recurrence.
Late recurrence substantially limits the efficacy of pulmonary vein isolation for AF and is associated with pulmonary vein reconnection and the emergence of new triggers.
Three-year follow-up was performed of the CONFIRM (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation) trial, in which 92 consecutive patients with AF (70.7% persistent) underwent novel computational mapping. Ablation comprised source (focal impulse and rotor modulation [FIRM]) and then conventional ablation in 27 patients (FIRM guided) and conventional ablation alone in 65 patients (FIRM blinded). Patients were followed with implanted electrocardiographic monitors when possible (85.2% of FIRM-guided patients, 23.1% of FIRM-blinded patients).
FIRM mapping revealed a median of 2 (interquartile range: 1 to 2) rotors or focal sources in 97.7% of patients during AF. During a median follow-up period of 890 days (interquartile range: 224 to 1,563 days), compared to FIRM-blinded therapy, patients receiving FIRM-guided ablation maintained higher freedom from AF after 1.2 ± 0.4 procedures (median 1; interquartile range: 1 to 1) (77.8% vs. 38.5%, p = 0.001) and a single procedure (p < 0.001) and higher freedom from all atrial arrhythmias (p = 0.003). Freedom from AF was higher when ablation directly or coincidentally passed through sources than when it missed sources (p < 0.001).
FIRM-guided ablation is more durable than conventional trigger-based ablation in preventing 3-year AF recurrence. Future studies should investigate how ablation of patient-specific AF-sustaining rotors and focal sources alters the natural history of arrhythmia recurrence. (The Dynamics of Human Atrial Fibrillation; NCT01008722).</description><subject>Atrial Fibrillation - physiopathology</subject><subject>Atrial Fibrillation - surgery</subject><subject>Biological and medical sciences</subject><subject>Cardiac dysrhythmias</subject><subject>Cardiology. Vascular system</subject><subject>Catheter Ablation - methods</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart</subject><subject>Heart Conduction System - physiopathology</subject><subject>Heart Conduction System - surgery</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Prospective Studies</subject><subject>Pulmonary Veins - surgery</subject><subject>Secondary Prevention</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNptUctu1DAUDS_RofADLJA3SGWR4Eec2OxGUQdGmlJpaMVy5LFv2oySOHVsaP8epxPKhtXR1T2Pe3ST5D3BGcGk-HzIDkrrjGKSZ5hmPGfPkwXhXKSMy_JlssAl4ynBsjxJ3ozjAWNcCCJfJyc0LxilAi-evVjuW-Ub2yNbo6311iHVG7SyWrXohw1Ow4i2YMKEG-UhDjo4B72GSbL0ronMVbN3TTs7VbYblAODfjb-Fl255uYGHHoKWra2hy_o_N5Db2DKalv7O70eJj9_C6i6_L5aby8mZbQ-q2z_C_pJGqcnlzpe-r_wx8y4m9AGPzdZd0NoR3jsdmx5YU04Sj69TV7VKm7fzXiaXK_Or6pv6eby67pabtKB5sSnVAhdAIE8Z1xzRVVZGMIMrYVRhlIlcsExJqwwEjRne6lyCYWWUJdaSCLZaXJ29B2cvQsw-l3XjBri5T3YMO4Ip4RRyQmL1A8zNew7MLvBNZ1yD7u_j4uEjzNBjbFg7VSvm_EfT-QlxYKxP7K1qzc</recordid><startdate>20140506</startdate><enddate>20140506</enddate><creator>NARAYAN, Sanjiv M</creator><creator>BAYKANER, Tina</creator><creator>CLOPTON, Paul</creator><creator>SCHRICKER, Amir</creator><creator>LALANI, Gautam G</creator><creator>KRUMMEN, David E</creator><creator>SHIVKUMAR, Kalyanam</creator><creator>MILLER, John M</creator><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>20140506</creationdate><title>Ablation of Rotor and Focal Sources Reduces Late Recurrence of Atrial Fibrillation Compared With Trigger Ablation Alone: Extended Follow-Up of the CONFIRM Trial (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation)</title><author>NARAYAN, Sanjiv M ; BAYKANER, Tina ; CLOPTON, Paul ; SCHRICKER, Amir ; LALANI, Gautam G ; KRUMMEN, David E ; SHIVKUMAR, Kalyanam ; MILLER, John M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p241t-288c6e1e4435c5a2a76d13d2f8dad22a848500136d9ec53b9a49e6c9ef7c89193</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Atrial Fibrillation - physiopathology</topic><topic>Atrial Fibrillation - surgery</topic><topic>Biological and medical sciences</topic><topic>Cardiac dysrhythmias</topic><topic>Cardiology. Vascular system</topic><topic>Catheter Ablation - methods</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart</topic><topic>Heart Conduction System - physiopathology</topic><topic>Heart Conduction System - surgery</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Prospective Studies</topic><topic>Pulmonary Veins - surgery</topic><topic>Secondary Prevention</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>NARAYAN, Sanjiv M</creatorcontrib><creatorcontrib>BAYKANER, Tina</creatorcontrib><creatorcontrib>CLOPTON, Paul</creatorcontrib><creatorcontrib>SCHRICKER, Amir</creatorcontrib><creatorcontrib>LALANI, Gautam G</creatorcontrib><creatorcontrib>KRUMMEN, David E</creatorcontrib><creatorcontrib>SHIVKUMAR, Kalyanam</creatorcontrib><creatorcontrib>MILLER, John M</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>NARAYAN, Sanjiv M</au><au>BAYKANER, Tina</au><au>CLOPTON, Paul</au><au>SCHRICKER, Amir</au><au>LALANI, Gautam G</au><au>KRUMMEN, David E</au><au>SHIVKUMAR, Kalyanam</au><au>MILLER, John M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ablation of Rotor and Focal Sources Reduces Late Recurrence of Atrial Fibrillation Compared With Trigger Ablation Alone: Extended Follow-Up of the CONFIRM Trial (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation)</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2014-05-06</date><risdate>2014</risdate><volume>63</volume><issue>17</issue><spage>1761</spage><epage>1768</epage><pages>1761-1768</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><abstract>The aim of this study was to determine if ablation that targets patient-specific atrial fibrillation (AF)-sustaining substrates (rotors or focal sources) is more durable than trigger ablation alone at preventing late AF recurrence.
Late recurrence substantially limits the efficacy of pulmonary vein isolation for AF and is associated with pulmonary vein reconnection and the emergence of new triggers.
Three-year follow-up was performed of the CONFIRM (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation) trial, in which 92 consecutive patients with AF (70.7% persistent) underwent novel computational mapping. Ablation comprised source (focal impulse and rotor modulation [FIRM]) and then conventional ablation in 27 patients (FIRM guided) and conventional ablation alone in 65 patients (FIRM blinded). Patients were followed with implanted electrocardiographic monitors when possible (85.2% of FIRM-guided patients, 23.1% of FIRM-blinded patients).
FIRM mapping revealed a median of 2 (interquartile range: 1 to 2) rotors or focal sources in 97.7% of patients during AF. During a median follow-up period of 890 days (interquartile range: 224 to 1,563 days), compared to FIRM-blinded therapy, patients receiving FIRM-guided ablation maintained higher freedom from AF after 1.2 ± 0.4 procedures (median 1; interquartile range: 1 to 1) (77.8% vs. 38.5%, p = 0.001) and a single procedure (p < 0.001) and higher freedom from all atrial arrhythmias (p = 0.003). Freedom from AF was higher when ablation directly or coincidentally passed through sources than when it missed sources (p < 0.001).
FIRM-guided ablation is more durable than conventional trigger-based ablation in preventing 3-year AF recurrence. Future studies should investigate how ablation of patient-specific AF-sustaining rotors and focal sources alters the natural history of arrhythmia recurrence. (The Dynamics of Human Atrial Fibrillation; NCT01008722).</abstract><cop>New York, NY</cop><pub>Elsevier</pub><pmid>24632280</pmid><doi>10.1016/j.jacc.2014.02.543</doi><tpages>8</tpages></addata></record> |
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| subjects | Atrial Fibrillation - physiopathology Atrial Fibrillation - surgery Biological and medical sciences Cardiac dysrhythmias Cardiology. Vascular system Catheter Ablation - methods Electrocardiography Female Follow-Up Studies Heart Heart Conduction System - physiopathology Heart Conduction System - surgery Humans Male Medical sciences Middle Aged Prospective Studies Pulmonary Veins - surgery Secondary Prevention Time Factors Treatment Outcome |
| title | Ablation of Rotor and Focal Sources Reduces Late Recurrence of Atrial Fibrillation Compared With Trigger Ablation Alone: Extended Follow-Up of the CONFIRM Trial (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation) |
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