Abstract 19701: Is Acute Procedural or Extended Outcome Dependent Upon Spontaneous Atrial Fibrillation During Focal Impulse and Rotor Modulation?
Introduction: Focal impulse and rotor modulation ablation (FIRM) was based on the premise that atrial fibrillation (AF) is sustained by rotors sufficiently stable in space to be eliminated by targeted ablation. Early experience reported very high success as compared to conventional strategies. We report on the largest single-center experience with extended follow-up using FIRM in a variety of AF pts.
Hypothesis: Is Acute Procedural or Extended Outcome Dependent Upon Spontaneous Atrial Fibrillation During Focal Impulse and Rotor Modulation?
Methods: All FIRM-guided procedures (n = 47) attempted at our site were included. During spontaneous or induced AF (sustained for ≥ 5 minutes), FIRM software constructed phase maps to identify putative AF rotors/sources. These sites were targeted for radiofrequency ablation, with adjunctive pulmonary vein re-isolation (PVI) if needed. Acute procedure success was defined as AF termination and long term success as freedom from documented recurrent AF > 30 secs after a 3-month blanking period.
Results: Sustained AF could not be induced in 4 pts in sinus rhythm who did not undergo FIRM. Out of remaining 43 pts, AF was induced in 20 pts (47%). Most pts had persistent AF and had at least one prior AF ablation (See Table). Amongst baseline clinical characteristics, only obstructive sleep apnea was more common in pts with spontaneous vs induced AF (35% vs 10%, p=0.05). Acute termination of AF in induced group occurred in 4 (20%) vs 1 (4.3%) in spontaneous pts (p =0.1) At 16 ± 10.7 mos (range 1-34 mos), only 3 pts (15%) amongst induced AF group were AF free vs 2 pts (10%) in spontaneous group (p = 0.63) (see Figure).
Conclusions: The presence of spontaneous vs induced AF was associated with no significant differences in acute procedural as well as extended clinical follow-up outcomes when using FIRM for treatment of AF. In particular, long-term freedom from AF was poor.
Author Disclosures: Y. Shah: None. M. Ferrara: None. E. Hansinger: None. D. Musat: None. T. Sichrovsky: None. M. Preminger: None. S. Mittal: None. J.S. Steinberg: None.
- © 2016 by American Heart Association, Inc.