Abstract 16980: Focal Impulse and Rotor Modulation for Atrial Fibrillation (AF) Ablation: Acute Response Based on Age and AF Type
Introduction: Focal Impulse and Rotor Modulation (FIRM) is a novel intervention designed to map and ablate presumed fixed sources of atrial fibrillation (AF). Because it is not known if patients (pts) of all ages with various AF types benefit to the same extent, we studied differences of acute response during FIRM-guided ablation based on pt age and AF type.
Methods: From the CONFIRM multicenter registry, all mapped pts were divided into 4 groups based on age less or more than/equal 60 years and persistent AF (PeAF) vs paroxysmal AF (PAF). AF was recorded using 64 pole-basket catheters and propagation maps created to identify rotors or focal sources. These were ablated for an acute composite endpoint of AF termination or slowing (more than 10% AF cycle length increase). Following initial FIRM-guided ablation, pulmonary vein isolation (and linear lesions in PeAF) were also performed. Acute responses to FIRM ablation were compared between groups.
Results: Of 129 pts treated with FIRM, 36 (28%) were < 60 years and 33 (26%) had PAF. FIRM-guided ablation resulted in much higher acute composite response, 97% vs 75% (p=0.004) in younger vs. older pts, regardless of AF type (Table). Pts with PAF had high acute composite endpoint regardless of age (100% age < 60 vs 95% age ≥ 60 yrs). Older pts with PeAF had lowest acute response (70%).
Conclusion: FIRM-guided ablation yielded high acute endpoint success in young pts regardless of AF type and in PAF pts regardless of age. Prospective follow-up is underway to evaluate if the differential acute success translates into comparable long-term response.
- © 2013 by American Heart Association, Inc.