Focal impulse and rotor modulation as a stand-alone procedure for the treatment of paroxysmal atrial fibrillation: A within-patient controlled study with implanted cardiac monitoring
Background Focal impulse and rotor modulation (FIRM) has been proposed as a novel approach for the treatment of atrial fibrillation (AF). Objective This study aimed to investigate the efficacy of FIRM as a stand-alone procedure for the treatment of paroxysmal AF. Methods A total of 27 patients with...
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| Veröffentlicht in: | Heart rhythm 2016-09, Vol.13 (9), p.1768-1774 |
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| creator | Berntsen, Rolf Franck, MD, PhD Håland, Trine Fink, MD Skårdal, Rita, RN Holm, Torbjørn, MD, PhD |
| description | Background Focal impulse and rotor modulation (FIRM) has been proposed as a novel approach for the treatment of atrial fibrillation (AF). Objective This study aimed to investigate the efficacy of FIRM as a stand-alone procedure for the treatment of paroxysmal AF. Methods A total of 27 patients with paroxysmal AF underwent sequential biatrial computational mapping. Sites with repetitive centrifugal or spiral reentry-like activity were considered to be AF-sustaining sources and targeted by irrigated radiofrequency (RF) ablation. All patients were seen in the outpatient clinic after 1, 3, and 6 months and thereafter every 6 months. Cardiac monitors were implanted 3 months before ablation in 17 patients (63%). Results Repetitive activity interpreted as sustained AF sources was found in all patients, with an average of 3.0 ± 1.1 sources located in the left atrium and 0.6 ± 0.6 sources in the right atrium. The majority of sources were rotors (95%). The total source-ablation radiofrequency time was 20.0 ± 9.0 minutes. At 15.2 ± 3.9 months of follow-up, the prespecified end point of |
| doi_str_mv | 10.1016/j.hrthm.2016.04.016 |
| format | Article |
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Objective This study aimed to investigate the efficacy of FIRM as a stand-alone procedure for the treatment of paroxysmal AF. Methods A total of 27 patients with paroxysmal AF underwent sequential biatrial computational mapping. Sites with repetitive centrifugal or spiral reentry-like activity were considered to be AF-sustaining sources and targeted by irrigated radiofrequency (RF) ablation. All patients were seen in the outpatient clinic after 1, 3, and 6 months and thereafter every 6 months. Cardiac monitors were implanted 3 months before ablation in 17 patients (63%). Results Repetitive activity interpreted as sustained AF sources was found in all patients, with an average of 3.0 ± 1.1 sources located in the left atrium and 0.6 ± 0.6 sources in the right atrium. The majority of sources were rotors (95%). The total source-ablation radiofrequency time was 20.0 ± 9.0 minutes. At 15.2 ± 3.9 months of follow-up, the prespecified end point of <1% AF burden (outside a 3-month blanking period) was achieved in 2 of the 17 continuously monitored patients (12%). Of all the 27 patients who underwent FIRM, AF episodes of ≥30 minutes were recorded in 23 (85%), while AF episodes ≥60 minutes were recorded in 21 patients (78%). Conclusion This study suggest that biatrial ablation of localized patient-specific sources alone, as detected by this method, is not sufficient to reduce paroxysmal AF burden in the majority of patients.</description><identifier>ISSN: 1547-5271</identifier><identifier>EISSN: 1556-3871</identifier><identifier>DOI: 10.1016/j.hrthm.2016.04.016</identifier><identifier>PMID: 27132150</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Atrial fibrillation ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - physiopathology ; Atrial Fibrillation - surgery ; Body Surface Potential Mapping ; Cardiovascular ; Catheter ablation ; Catheter Ablation - methods ; Electrocardiography ; Electrodes, Implanted ; Female ; Fluoroscopy ; Humans ; Imaging, Three-Dimensional ; Male ; Mapping ; Middle Aged ; Monitoring, Intraoperative ; Perioperative Care ; Radiofrequency ; Rotors</subject><ispartof>Heart rhythm, 2016-09, Vol.13 (9), p.1768-1774</ispartof><rights>Heart Rhythm Society</rights><rights>2016 Heart Rhythm Society</rights><rights>Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c414t-2979dc4ed4466e0f93d82486c04b934ad1f9f6e0386babdf8e1678858c9c27283</citedby><cites>FETCH-LOGICAL-c414t-2979dc4ed4466e0f93d82486c04b934ad1f9f6e0386babdf8e1678858c9c27283</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1547527116302570$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27132150$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Berntsen, Rolf Franck, MD, PhD</creatorcontrib><creatorcontrib>Håland, Trine Fink, MD</creatorcontrib><creatorcontrib>Skårdal, Rita, RN</creatorcontrib><creatorcontrib>Holm, Torbjørn, MD, PhD</creatorcontrib><title>Focal impulse and rotor modulation as a stand-alone procedure for the treatment of paroxysmal atrial fibrillation: A within-patient controlled study with implanted cardiac monitoring</title><title>Heart rhythm</title><addtitle>Heart Rhythm</addtitle><description>Background Focal impulse and rotor modulation (FIRM) has been proposed as a novel approach for the treatment of atrial fibrillation (AF). Objective This study aimed to investigate the efficacy of FIRM as a stand-alone procedure for the treatment of paroxysmal AF. Methods A total of 27 patients with paroxysmal AF underwent sequential biatrial computational mapping. Sites with repetitive centrifugal or spiral reentry-like activity were considered to be AF-sustaining sources and targeted by irrigated radiofrequency (RF) ablation. All patients were seen in the outpatient clinic after 1, 3, and 6 months and thereafter every 6 months. Cardiac monitors were implanted 3 months before ablation in 17 patients (63%). Results Repetitive activity interpreted as sustained AF sources was found in all patients, with an average of 3.0 ± 1.1 sources located in the left atrium and 0.6 ± 0.6 sources in the right atrium. The majority of sources were rotors (95%). The total source-ablation radiofrequency time was 20.0 ± 9.0 minutes. At 15.2 ± 3.9 months of follow-up, the prespecified end point of <1% AF burden (outside a 3-month blanking period) was achieved in 2 of the 17 continuously monitored patients (12%). Of all the 27 patients who underwent FIRM, AF episodes of ≥30 minutes were recorded in 23 (85%), while AF episodes ≥60 minutes were recorded in 21 patients (78%). Conclusion This study suggest that biatrial ablation of localized patient-specific sources alone, as detected by this method, is not sufficient to reduce paroxysmal AF burden in the majority of patients.</description><subject>Adult</subject><subject>Aged</subject><subject>Atrial fibrillation</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Atrial Fibrillation - surgery</subject><subject>Body Surface Potential Mapping</subject><subject>Cardiovascular</subject><subject>Catheter ablation</subject><subject>Catheter Ablation - methods</subject><subject>Electrocardiography</subject><subject>Electrodes, Implanted</subject><subject>Female</subject><subject>Fluoroscopy</subject><subject>Humans</subject><subject>Imaging, Three-Dimensional</subject><subject>Male</subject><subject>Mapping</subject><subject>Middle Aged</subject><subject>Monitoring, Intraoperative</subject><subject>Perioperative Care</subject><subject>Radiofrequency</subject><subject>Rotors</subject><issn>1547-5271</issn><issn>1556-3871</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUstu1TAQjRCIlsIXICEv2ST4lcRBAqmqKCBVYgGsLceecH1J7IvtAPfH-D4mvYUFG1Zjz5wzrzNV9ZTRhlHWvdg3u1R2S8Px01DZoLlXnbO27WqhenZ_e8u-bnnPzqpHOe8p5UNHxcPqDF2Cs5aeV7-uozUz8cthnTMQExxJscRElujW2RQfAzGZGJILxmozxwDkkKIFtyYgEyLLDkhJYMoCoZA4kYNJ8ecxL5jXlOTRTH5Mfj6le0kuyQ9fdj7UB3RsHBtDSXGewWGZ1R1v41tPswkFndYk543FnoLH3nz48rh6MBls-Mmdvag-X7_5dPWuvvnw9v3V5U1tJZOl5kM_OCvBSdl1QKdBOMWl6iyV4yCkcWwaJgwI1Y1mdJMC1vVKtcoOlvdciYvq-SkvjvxthVz04rMFHCVAXLNmikkmBtoKhIoT1KaYc4JJH5JfTDpqRvUmmN7rW8H0JpimUqNB1rO7Auu4gPvL-aMQAl6dAIBjfveQdLa4NNy_T2CLdtH_p8Drf_h29sGj6F_hCHkf1xRwg5rpzDXVH7eb2U4GqZS3PRW_AcURwcU</recordid><startdate>20160901</startdate><enddate>20160901</enddate><creator>Berntsen, Rolf Franck, MD, PhD</creator><creator>Håland, Trine Fink, MD</creator><creator>Skårdal, Rita, RN</creator><creator>Holm, Torbjørn, MD, PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160901</creationdate><title>Focal impulse and rotor modulation as a stand-alone procedure for the treatment of paroxysmal atrial fibrillation: A within-patient controlled study with implanted cardiac monitoring</title><author>Berntsen, Rolf Franck, MD, PhD ; Håland, Trine Fink, MD ; Skårdal, Rita, RN ; Holm, Torbjørn, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c414t-2979dc4ed4466e0f93d82486c04b934ad1f9f6e0386babdf8e1678858c9c27283</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Atrial fibrillation</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Atrial Fibrillation - surgery</topic><topic>Body Surface Potential Mapping</topic><topic>Cardiovascular</topic><topic>Catheter ablation</topic><topic>Catheter Ablation - methods</topic><topic>Electrocardiography</topic><topic>Electrodes, Implanted</topic><topic>Female</topic><topic>Fluoroscopy</topic><topic>Humans</topic><topic>Imaging, Three-Dimensional</topic><topic>Male</topic><topic>Mapping</topic><topic>Middle Aged</topic><topic>Monitoring, Intraoperative</topic><topic>Perioperative Care</topic><topic>Radiofrequency</topic><topic>Rotors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Berntsen, Rolf Franck, MD, PhD</creatorcontrib><creatorcontrib>Håland, Trine Fink, MD</creatorcontrib><creatorcontrib>Skårdal, Rita, RN</creatorcontrib><creatorcontrib>Holm, Torbjørn, MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Heart rhythm</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Berntsen, Rolf Franck, MD, PhD</au><au>Håland, Trine Fink, MD</au><au>Skårdal, Rita, RN</au><au>Holm, Torbjørn, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Focal impulse and rotor modulation as a stand-alone procedure for the treatment of paroxysmal atrial fibrillation: A within-patient controlled study with implanted cardiac monitoring</atitle><jtitle>Heart rhythm</jtitle><addtitle>Heart Rhythm</addtitle><date>2016-09-01</date><risdate>2016</risdate><volume>13</volume><issue>9</issue><spage>1768</spage><epage>1774</epage><pages>1768-1774</pages><issn>1547-5271</issn><eissn>1556-3871</eissn><abstract>Background Focal impulse and rotor modulation (FIRM) has been proposed as a novel approach for the treatment of atrial fibrillation (AF). Objective This study aimed to investigate the efficacy of FIRM as a stand-alone procedure for the treatment of paroxysmal AF. Methods A total of 27 patients with paroxysmal AF underwent sequential biatrial computational mapping. Sites with repetitive centrifugal or spiral reentry-like activity were considered to be AF-sustaining sources and targeted by irrigated radiofrequency (RF) ablation. All patients were seen in the outpatient clinic after 1, 3, and 6 months and thereafter every 6 months. Cardiac monitors were implanted 3 months before ablation in 17 patients (63%). Results Repetitive activity interpreted as sustained AF sources was found in all patients, with an average of 3.0 ± 1.1 sources located in the left atrium and 0.6 ± 0.6 sources in the right atrium. The majority of sources were rotors (95%). The total source-ablation radiofrequency time was 20.0 ± 9.0 minutes. At 15.2 ± 3.9 months of follow-up, the prespecified end point of <1% AF burden (outside a 3-month blanking period) was achieved in 2 of the 17 continuously monitored patients (12%). Of all the 27 patients who underwent FIRM, AF episodes of ≥30 minutes were recorded in 23 (85%), while AF episodes ≥60 minutes were recorded in 21 patients (78%). Conclusion This study suggest that biatrial ablation of localized patient-specific sources alone, as detected by this method, is not sufficient to reduce paroxysmal AF burden in the majority of patients.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27132150</pmid><doi>10.1016/j.hrthm.2016.04.016</doi><tpages>7</tpages></addata></record> |
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| subjects | Adult Aged Atrial fibrillation Atrial Fibrillation - diagnosis Atrial Fibrillation - physiopathology Atrial Fibrillation - surgery Body Surface Potential Mapping Cardiovascular Catheter ablation Catheter Ablation - methods Electrocardiography Electrodes, Implanted Female Fluoroscopy Humans Imaging, Three-Dimensional Male Mapping Middle Aged Monitoring, Intraoperative Perioperative Care Radiofrequency Rotors |
| title | Focal impulse and rotor modulation as a stand-alone procedure for the treatment of paroxysmal atrial fibrillation: A within-patient controlled study with implanted cardiac monitoring |
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