Ablation of rotor and focal sources reduces late recurrence of atrial fibrillation compared with trigger ablation alone: Extended follow-up of the CONFIRM trial (conventional ablation for atrial fibrillation with or without focal impulse and rotor modulation)

Journal of the American College of Cardiology

Volumn 63, Issue 17, 2014, Pages 1761-1768

  Narayan, Sanjiv M ^a,b   Baykaner, Tina ^a,b   Clopton, Paul ^b   Schricker, Amir ^a,b   Lalani, Gautam G ^a,b   Krummen, David E ^a,b   Shivkumar, Kalyanam ^c   Miller, John M ^d  

^a UNIVERSITY OF CALIFORNIA SAN DIEGO   (United States)

^b VA SAN DIEGO HEALTHCARE SYSTEM   (United States)

^c UNIVERSITY OF CALIFORNIA   (United States)

^d INDIANA UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

ablation; atrial fibrillation; clinical trial; electrical rotors; FIRM

Indexed keywords

ABLATION THERAPY; ADULT; ARTICLE; CLINICAL EFFECTIVENESS; COMPARATIVE STUDY; CONTROLLED STUDY; CONVENTIONAL ABLATION; FEMALE; FOCAL IMPULSE AND ROTOR MODULATION; HEART ATRIUM FIBRILLATION; HUMAN; HYPERTENSION; MAJOR CLINICAL STUDY; MALE; PRIORITY JOURNAL; RECURRENCE FREE SURVIVAL; RECURRENT DISEASE; REPEAT PROCEDURE; SLEEP DISORDERED BREATHING; TACHYCARDIA; TREATMENT RESPONSE;

ABLATION; ATRIAL FIBRILLATION; CLINICAL TRIAL; ELECTRICAL ROTORS; FIRM;

ATRIAL FIBRILLATION; CATHETER ABLATION; ELECTROCARDIOGRAPHY; FEMALE; FOLLOW-UP STUDIES; HEART CONDUCTION SYSTEM; HUMANS; MALE; MIDDLE AGED; PROSPECTIVE STUDIES; PULMONARY VEINS; RECURRENCE; TIME FACTORS; TREATMENT OUTCOME;

EID: 84899635276     PISSN: 07351097     EISSN: 15583597     Source Type: Journal    
DOI: 10.1016/j.jacc.2014.02.543     Document Type: Article

References (40)

1. C.H. Calkins 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design Heart Rhythm 9 2012 632 696
2. D. Roy, M. Talajic, and S. Nattel et al. Rhythm control versus rate control for atrial fibrillation and heart failure N Engl J Med 358 2008 2667 2677
3. I.C. Van Gelder, H.F. Groenveld, and H.J. Crijns et al. Lenient versus strict rate control in patients with atrial fibrillation N Engl J Med 362 2010 1363 1373
4. R. Weerasooriya, P. Khairy, and J. Litalien et al. Catheter ablation for atrial fibrillation: are results maintained at 5 years of follow-up? J Am Coll Cardiol 57 2011 160 166
5. D.J. Wilber, C. Pappone, and P. Neuzil et al. Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial JAMA 303 2010 333 340
6. F. Ouyang, M. Antz, and S. Ernst et al. Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons from double lasso technique Circulation 111 2005 127 135
7. A. Verma, F. Kilicaslan, and E. Pisano et al. Response of atrial fibrillation to pulmonary vein antrum isolation is directly related to resumption and delay of pulmonary vein conduction Circulation 112 2005 627 635
8. C. Schmitt, G. Ndrepepa, and S. Weber et al. Biatrial multisite mapping of atrial premature complexes triggering onset of atrial fibrillation Am J Cardiol 89 2002 1381 1387
9. C.S. Elayi, L. Di Biase, and C. Barrett et al. Atrial fibrillation termination as a procedural endpoint during ablation in long-standing persistent atrial fibrillation Heart Rhythm 7 2010 1216 1223
10. S. Dixit, F.E. Marchlinski, and D. Lin et al. Randomized ablation strategies for the treatment of persistent atrial fibrillation: RASTA study Circ Arrhythm Electrophysiol 5 2012 287 294
11. S.M. Narayan, D.E. Krummen, K. Shivkumar, P. Clopton, W.-J. Rappel, and J. Miller Treatment of atrial fibrillation by the ablation of localized sources: the Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation: CONFIRM trial J Am Coll Cardiol 60 2012 628 636
12. K. Shivkumar, K.A. Ellenbogen, J.D. Hummel, J.M. Miller, and J.S. Steinberg Acute termination of human atrial fibrillation by identification and catheter ablation of localized rotors and sources: first multicenter experience of focal impulse and rotor modulation (FIRM) ablation J Cardiovasc Electrophysiol 23 2012 1277 1285
13. J.M. Miller, J. Daubert, and J. Day et al. Long-term results of patients receiving focal impulse and rotor modulation (FIRM) for atrial fibrillation: extended multi-center experience (abstr) Circulation 128 2013 A16890
14. S.M. Narayan, D.E. Krummen, and W.-J. Rappel Clinical mapping approach to identify rotors and focal beats in human atrial fibrillation J Cardiovasc Electrophysiol 23 2012 447 454
15. S.M. Narayan, P. Clopton, D.E. Krummen, K. Shivkumar, and J. Miller Direct or concidental ablation of localized sources may explain the success of atrial fibrillation ablation. On treatment analysis from the CONFIRM trial J Am Coll Cardiol 62 2013 138 147
16. D. Calvo, F. Atienza, and J. Jalife et al. High-rate pacing-induced atrial fibrillation effectively reveals properties of spontaneously occurring paroxysmal atrial fibrillation in humans Europace 14 2012 1560 1566
17. S.M. Narayan, K. Shivkumar, D.E. Krummen, J.M. Miller, and W.-J. Rappel Panoramic electrophysiological mapping but not individual electrogram morphology identifies sustaining sites for human atrial fibrillation (AF rotors and focal sources relate poorly to fractionated electrograms) Circ Arrhythm Electrophysiol 6 2013 58 67
18. Y.J. Lin, M.T. Lo, and C. Lin et al. Prevalence, characteristics, mapping, and catheter ablation of potential rotors in nonparoxysmal atrial fibrillation Circ Arrhythm Electrophysiol 6 2013 851 858
19. C. Morillo, A. Verma, and K.H. Kuck et al. Radiofrequency Ablation vs Antiarrhythmic Drugs as First-Line Treatment of Symptomatic Atrial Fibrillation: (RAAFT 2): a randomized trial (abstr) Heart Rhythm 9 2012 1580
20. J.C. Nielsen, A. Johannessen, and P. Raatikainen et al. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation N Engl J Med 367 2012 1587 1595
21. S.M. Narayan, D.E. Krummen, A. Donsky, V. Swarup, and J.M. Miller Precise Rotor Elimination without Concomitant pulmonary vein Isolation for the Successful Elimination of Paroxysmal Atrial Fibrillation. PRECISE-PAF Heart Rhythm 10 2013 LBCT4
22. M.A. Allessie, N.M. de Groot, and R.P. Houben et al. The electropathological substrate of longstanding persistent atrial fibrillation in patients with structural heart disease: longitudinal dissociation Circ Arrhythm Electrophysiol 122 2010 1674 1682
23. B. Herweg, M. Kowalski, and J.S. Steinberg Termination of persistent atrial fibrillation resistant to cardioversion by a single radiofrequency application Pacing Clin Electrophysiol 26 2003 1420 1423
24. W.S. Tzou, L. Saghy, and D. Lin Termination of persistent atrial fibrillation during left atrial mapping J Cardiovasc Electrophysiol 22 2011 1171 1173
25. E. Gerstenfeld, A. Sahakian, and S. Swiryn Evidence for transient linking of atrial excitation during atrial fibrillation in humans Circulation 86 1992 375 382
26. G. Lee, S. Kumar, and A. Teh et al. Epicardial wave mapping in human long-lasting persistent AF. Rotors, complex wavefronts and disorganized activity Eur Heart J 35 2014 86 97
27. T.-J. Wu, R.N. Doshi, and H.-L.A. Huang et al. Simultaneous biatrial computerized mapping during permanent atrial fibrillation in patients with organic heart disease J Cardiovasc Electrophysiol 13 2002 571 577
28. J. Sahadevan, K. Ryu, and L. Peltz et al. Epicardial mapping of chronic atrial fibrillation in patients: preliminary observations Circulation 110 2004 3293 3299
29. P. Sanders, O. Berenfeld, and M. Hocini et al. Spectral analysis identifies sites of high-frequency activity maintaining atrial fibrillation in humans Circulation 112 2005 789 797
30. K. Lemola, M. Ting, and P. Gupta et al. Effects of two different catheter ablation techniques on spectral characteristics of atrial fibrillation J Am Coll Cardiol 48 2006 340 348
31. F. Atienza, J. Almendral, and J. Jalife et al. Real-time dominant frequency mapping and ablation of dominant frequency sites in atrial fibrillation with left-to-right frequency gradients predicts long-term maintenance of sinus rhythm Heart Rhythm 6 2009 33 40
32. Y.-J. Lin, C.-T. Tai, and T. Kao et al. Electrophysiological characteristics and catheter ablation in patients with paroxysmal right atrial fibrillation Circulation 112 2005 1692 1700
33. M. Haissaguerre, M. Hocini, and A.J. Shah et al. Noninvasive panoramic mapping of human atrial fibrillation mechanisms: a feasibility report J Cardiovasc Electrophysiol 24 2013 711 717
34. A.N. Ganesan, P. Kuklik, and D.H. Lau et al. Bipolar electrogram shannon entropy at sites of rotational activation: implications for ablation of atrial fibrillation Circ Arrhythm Electrophysiol 6 2013 48 57
35. S. Nattel New ideas about atrial fibrillation 50 years on Nature 415 2002 219 226
36. R.S. Oakes, T.J. Badger, and E.G. Kholmovski et al. Detection and quantification of left atrial structural remodeling with delayed-enhancement magnetic resonance imaging in patients with atrial fibrillation Circulation 119 2009 1758 1767
37. B.J. Scherlag, H. Nakagawa, and W.M. Jackman et al. Electrical stimulation to identify neural elements on the heart: their role in atrial fibrillation J Interv Card Electrophysiol 13 2005 37 42
38. C. Pratola, E. Baldo, P. Notarstefano, T. Toselli, and R. Ferrari Radiofrequency ablation of atrial fibrillation: is the persistence of all intraprocedural targets necessary for long-term maintenance of sinus rhythm? Circulation 117 2008 136 143
39. K.-H. Kuck, S. Willems, and G. Breithardt GAP-AF trial - AFNET1: (late breaking clinical trial abstract) Europace 2014 Mar 13 [E-pub ahead of print].
40. T. Baykaner, P. Clopton, A.A. Schricker, G. Lalani, D.E. Krummen, and S.M. Narayan Targeted ablation at stable atrial fibrillation sources improves success over conventional ablation in high risk patients: a substudy of the CONFIRM trial Can J Cardiol 29 2013 1218 1226