Abstract 14906: Clinical Outcomes of Focal Impulse and Rotor Modulation for Treatment of Atrial Fibrillation: Single-Center Experience
Catheter ablation for atrial fibrillation (AF) using Focal Impulse and Rotor Modulation (FIRM) mapping has shown promise in the treatment of AF in early studies. We performed a retrospective, observational study of 23 patients who underwent 24 FIRM-guided catheter ablation procedures for paroxysmal or persistent AF. Patients were asked to follow up in clinic and with event monitors at 3, 6 and 12 months post-procedure. Long-term outcomes were assessed after a 3-month blanking period. Primary efficacy endpoints were freedom from AF and all atrial tachyarrhythmias (ATA) off antiarrhythmic drugs (AAD). Study population consisted of all patients undergoing FIRM-guided AF ablation between January 2012 and July 2013 at UCLA Medical Center. Half were persistent, mean age was 63, mean AF duration 7.3 years, and mean left atrial volume 76.2mL. The majority of patients had failed AAD therapy (92%) and prior ablation (63%). All patients underwent FIRM-guided ablation, with 19 (79%) also undergoing pulmonary vein isolation (PVI). After mean 509 ± 168 days of follow up, single-procedure freedom from AF, all ATA and all ATA off AAD was 45.8%, 37.5% and 29.2%, respectively. Two patients (8.3%) died during follow-up, one from atrioesophageal fistula and one from complications of surgical maze procedure following arrhythmia recurrence. Complete follow-up monitoring was achieved in 42% of patients. Subgroup analysis showed no statistically significant difference between those with paroxysmal and persistent AF, those who underwent FIRM-only vs. FIRM and PVI, and in those undergoing their first vs. repeat ablation. None of the 5 patients that underwent FIRM-guided ablation alone were free from all ATA. Results of FIRM-guided ablation for AF at our center were disappointing. Randomized, prospective trials should be performed before wide implementation of this technology.
Author Disclosures: M. Share: None. R. Mandapati: None. K. Shivkumar: None. E. Buch: None.
- © 2014 by American Heart Association, Inc.