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Clinical Benefit of Ablating Localized Sources for Human Atrial Fibrillation: The Indiana University FIRM Registry

Miller, John M ; Kalra, Vikas ; Das, Mithilesh K ; Jain, Rahul ; Garlie, Jason B ; Brewster, Jordan A ; Dandamudi, Gopi

Journal of the American College of Cardiology, 2017-03, Vol.69 (10), p.1247-1256 [Revista revisada por pares]

United States: Elsevier Limited

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Clinical Benefit of Ablating Localized Sources for Human Atrial Fibrillation: The Indiana University FIRM Registry
Autor: Miller, John M ; Kalra, Vikas ; Das, Mithilesh K ; Jain, Rahul ; Garlie, Jason B ; Brewster, Jordan A ; Dandamudi, Gopi
Materias: Atrial Fibrillation - diagnosis ; Atrial Fibrillation - physiopathology ; Atrial Fibrillation - surgery ; Body Surface Potential Mapping - methods ; Cardiac arrhythmia ; Cardiology ; Catheter Ablation - methods ; Catheters ; Female ; Follow-Up Studies ; Heart Conduction System - physiopathology ; Heart Conduction System - surgery ; Humans ; Imaging, Three-Dimensional ; Indiana ; Male ; Mapping ; Middle Aged ; Patients ; Propagation ; Registries ; Retrospective Studies ; Treatment Outcome ; Universities - statistics & numerical data
Es parte de: Journal of the American College of Cardiology, 2017-03, Vol.69 (10), p.1247-1256
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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Descripción: Mounting evidence shows that localized sources maintain atrial fibrillation (AF). However, it is unclear in unselected "real-world" patients if sources drive persistent atrial fibrillation (PeAF), long-standing persistent atrial fibrillation (LPeAF), or paroxysmal atrial fibrillation (PAF); if right atrial sites are important; and what the long-term success of source ablation is. The aim of this study was to analyze the role of rotors and focal sources in a large academic registry of consecutive patients undergoing source mapping for AF. One hundred seventy consecutive patients (mean age 59 ± 12 years, 79% men) with PAF (37%), PeAF (31%), or LPeAF (32%). Of these, 73 (43%) had undergone at least 1 prior ablation attempt (mean 1.9 ± 0.8; range: 1 to 4). Focal impulse and rotor modulation (FIRM) with an endocardial basket catheter was used in all cases. FIRM analysis revealed sources in the right atrium in 85% of patients (1.8 ± 1.3) and in the left atrium in 90% of patients (2.0 ± 1.3). FIRM ablation terminated AF to sinus rhythm or atrial flutter or tachycardia in 59% (PAF), 37% (PeAF), and 19% (LPeAF) of patients, with 15 of 67 terminations due to right atrial ablation. On follow-up, freedom from AF after a single FIRM procedure for the entire series was 95% (PAF), 83% (PeAF), and 82% (LPeAF) at 1 year and freedom from all atrial arrhythmias was 77% (PAF), 75% (PeAF), and 57% (LPeAF). In the Indiana University FIRM registry, FIRM-guided ablation produced high single-procedure success, mostly in patients with nonparoxysmal AF. Data from mapping, acute terminations, and outcomes strongly support the mechanistic role of biatrial rotors and focal sources in maintaining AF in diverse populations. Randomized trials of FIRM-guided ablation and mechanistic studies to determine how rotors form, progress, and regress are needed.
Editor: United States: Elsevier Limited
Idioma: Inglés

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Clinical Benefit of Ablating Localized Sources for Human Atrial Fibrillation: The Indiana University FIRM Registry

Miller, John M ; Kalra, Vikas ; Das, Mithilesh K ; Jain, Rahul ; Garlie, Jason B ; Brewster, Jordan A ; Dandamudi, Gopi

United States: Elsevier Limited

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