Impact of Rotor Ablation in Nonparoxysmal Atrial Fibrillation Patients: Results From the Randomized OASIS Trial

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• 作者：Sanghamitra Mohanty ; MD^a ; Carola Gianni ; MD^a ; Prasant Mohanty ; MBBS ; MPH^a ; Philipp Halbfass ; MD^b ; Tamara Metz ; BSN ; RN^b ; Chintan Trivedi ; MD ; MPH^a ; Thomas Deneke ; MD^b ; Gery Tomassoni ; MD^c ; Rong Bai ; MD^a ; ^d ; Amin Al-Ahmad ; MD^a ; Shane Bailey ; MD^a ; John David Burkhardt ; MD^a ; G. Joseph Gallinghouse ; MD^a ; Rodney Horton ; MD^a ; Patrick M. Hranitzky ; MD^a ; Javier E. Sanchez ; MD^a ; Luigi Di Biase ; MD ; PhD^a ; ^b ; Andrea Natale ; MD^a ; ^c ; ^d ; ^e ; ^f ; ^g ; ^h ; ⁱ ; ^{dr.natale@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：FIRM-guided ablation ; nonparoxysmal AF ; non-PV triggers ; PVAI ; rotors
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：19 July 2016
• 年：2016
• 卷：68
• 期：3
• 页码：274-282
• 全文大小：1015 K

文摘

Nonrandomized studies have reported focal impulse and rotor modulation (FIRM)-guided ablation to be superior to pulmonary vein antrum isolation (PVAI) for persistent atrial fibrillation and long-standing persistent atrial fibrillation.

Objectives

This study sought to compare efficacy of FIRM ablation with or without PVAI versus PVAI plus non-PV trigger ablation in randomized persistent atrial fibrillation and long-standing persistent atrial fibrillation patients.

Methods

Nonparoxysmal atrial fibrillation (AF) patients undergoing first ablation were randomized to FIRM only (group 1), FIRM + PVAI (group 2) or PVAI + posterior wall + non-PV trigger ablation (group 3). Primary endpoint was freedom from atrial tachycardia/AF. The secondary endpoint was acute procedural success, defined as AF termination, ≥10% slowing, or organization into atrial tachycardia.

Results

A total of 113 patients were enrolled at 3 centers; 29 in group 1 and 42 each in groups 2 and 3. Group 1 enrollment was terminated early for futility. Focal drivers or rotors were detected in all group 1 and 2 patients. Procedure time was significantly shorter in group 3 versus groups 1 and 2 (p < 0.001). In groups 1 and 2, acute success after rotor-only ablation was achieved in 12 patients (41%) and 11 (26%), respectively. After 12 ± 7 months’ follow-up, 4 patients (14%), 22 (52.4%), and 32 (76%) in groups 1, 2, and 3, respectively, were AF/atrial tachycardia–free while off antiarrhythmic drugs (log-rank p < 0.0001). Group 3 patients experienced higher success compared with groups 1 (p < 0.001) and 2 (p = 0.02).

Conclusions

Outcomes were poor with rotor-only ablation. PVAI + rotor ablation had significantly longer procedure time and lower efficacy than PVAI + posterior wall + non-PV trigger-ablation. (Outcome of Different Ablation Strategies in Persistent and Long-Standing Persistent Atrial Fibrillation [OASIS]; NCT02533843)