Initial independent outcomes from focal impulse and rotor modulation ablation for atrial fibrillation

Multicenter FIRM registry

John Miller, Robert C. Kowal, Vijay Swarup, James P. Daubert, Emile G. Daoud, John D. Day, Kenneth A. Ellenbogen, John D. Hummel, Tina Baykaner, David E. Krummen, Sanjiv M. Narayan, Vivek Y. Reddy, Kalyanam Shivkumar, Jonathan S. Steinberg, Kevin R. Wheelan

Research output: Contribution to journalArticle

118 Citations (Scopus)

Abstract

Multicenter FIRM Registry for AF. Introduction: The success of pulmonary vein isolation (PVI) for atrial fibrillation (AF) may be improved if stable AF sources identified by Focal Impulse and Rotor Mapping (FIRM) are also eliminated. The long-term results of this approach are unclear outside the centers where FIRM was developed; thus, we assessed outcomes of FIRM-guided AF ablation in the first cases at 10 experienced centers.

Methods:We prospectively enrolled n=78 consecutive patients (61±10 years) undergoing FIRM guided ablation for persistent (n = 48), longstanding persistent (n = 7), or paroxysmal (n = 23) AF. AF recordings from both atria with a 64-pole basket catheter were analyzed using a novel mapping system (Rhythm ViewTM; Topera Inc., CA, USA). Identified rotors/focal sources were ablated, followed by PVI.

Results: Each institution recruited a median of 6 patients, each of whom showed 2.3 ± 0.9 AF rotors/focal sources in diverse locations. 25.3% of all sources were right atrial (RA), and 50.0% of patients had ≥1 RA source. Ablation of all sources required a total of 16.6 ± 11.7 minutes, followed by PVI. On >1 year follow-up with a 3-month blanking period, 1 patient lost to follow-up (median time to 1st recurrence: 245 days, IQR 145-354), single-procedure freedom from AF was 87.5% (patients without prior ablation; 35/40) and 80.5% (all patients; 62/77) and similar for persistent and paroxysmal AF (P = 0.89).

Original languageEnglish
Pages (from-to)921-929
Number of pages9
JournalJournal of Cardiovascular Electrophysiology
Volume25
Issue number9
DOIs
StatePublished - 2014

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Atrial Fibrillation
Registries
Pulmonary Veins
Lost to Follow-Up
Catheters
Recurrence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Initial independent outcomes from focal impulse and rotor modulation ablation for atrial fibrillation : Multicenter FIRM registry. / Miller, John; Kowal, Robert C.; Swarup, Vijay; Daubert, James P.; Daoud, Emile G.; Day, John D.; Ellenbogen, Kenneth A.; Hummel, John D.; Baykaner, Tina; Krummen, David E.; Narayan, Sanjiv M.; Reddy, Vivek Y.; Shivkumar, Kalyanam; Steinberg, Jonathan S.; Wheelan, Kevin R.

In: Journal of Cardiovascular Electrophysiology, Vol. 25, No. 9, 2014, p. 921-929.

Research output: Contribution to journalArticle

Miller, J, Kowal, RC, Swarup, V, Daubert, JP, Daoud, EG, Day, JD, Ellenbogen, KA, Hummel, JD, Baykaner, T, Krummen, DE, Narayan, SM, Reddy, VY, Shivkumar, K, Steinberg, JS & Wheelan, KR 2014, 'Initial independent outcomes from focal impulse and rotor modulation ablation for atrial fibrillation: Multicenter FIRM registry', Journal of Cardiovascular Electrophysiology, vol. 25, no. 9, pp. 921-929. https://doi.org/10.1111/jce.12474
Miller, John ; Kowal, Robert C. ; Swarup, Vijay ; Daubert, James P. ; Daoud, Emile G. ; Day, John D. ; Ellenbogen, Kenneth A. ; Hummel, John D. ; Baykaner, Tina ; Krummen, David E. ; Narayan, Sanjiv M. ; Reddy, Vivek Y. ; Shivkumar, Kalyanam ; Steinberg, Jonathan S. ; Wheelan, Kevin R. / Initial independent outcomes from focal impulse and rotor modulation ablation for atrial fibrillation : Multicenter FIRM registry. In: Journal of Cardiovascular Electrophysiology. 2014 ; Vol. 25, No. 9. pp. 921-929.
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abstract = "Multicenter FIRM Registry for AF. Introduction: The success of pulmonary vein isolation (PVI) for atrial fibrillation (AF) may be improved if stable AF sources identified by Focal Impulse and Rotor Mapping (FIRM) are also eliminated. The long-term results of this approach are unclear outside the centers where FIRM was developed; thus, we assessed outcomes of FIRM-guided AF ablation in the first cases at 10 experienced centers.Methods:We prospectively enrolled n=78 consecutive patients (61±10 years) undergoing FIRM guided ablation for persistent (n = 48), longstanding persistent (n = 7), or paroxysmal (n = 23) AF. AF recordings from both atria with a 64-pole basket catheter were analyzed using a novel mapping system (Rhythm ViewTM; Topera Inc., CA, USA). Identified rotors/focal sources were ablated, followed by PVI.Results: Each institution recruited a median of 6 patients, each of whom showed 2.3 ± 0.9 AF rotors/focal sources in diverse locations. 25.3{\%} of all sources were right atrial (RA), and 50.0{\%} of patients had ≥1 RA source. Ablation of all sources required a total of 16.6 ± 11.7 minutes, followed by PVI. On >1 year follow-up with a 3-month blanking period, 1 patient lost to follow-up (median time to 1st recurrence: 245 days, IQR 145-354), single-procedure freedom from AF was 87.5{\%} (patients without prior ablation; 35/40) and 80.5{\%} (all patients; 62/77) and similar for persistent and paroxysmal AF (P = 0.89).",
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AU - Miller, John

AU - Kowal, Robert C.

AU - Swarup, Vijay

AU - Daubert, James P.

AU - Daoud, Emile G.

AU - Day, John D.

AU - Ellenbogen, Kenneth A.

AU - Hummel, John D.

AU - Baykaner, Tina

AU - Krummen, David E.

AU - Narayan, Sanjiv M.

AU - Reddy, Vivek Y.

AU - Shivkumar, Kalyanam

AU - Steinberg, Jonathan S.

AU - Wheelan, Kevin R.

PY - 2014

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N2 - Multicenter FIRM Registry for AF. Introduction: The success of pulmonary vein isolation (PVI) for atrial fibrillation (AF) may be improved if stable AF sources identified by Focal Impulse and Rotor Mapping (FIRM) are also eliminated. The long-term results of this approach are unclear outside the centers where FIRM was developed; thus, we assessed outcomes of FIRM-guided AF ablation in the first cases at 10 experienced centers.Methods:We prospectively enrolled n=78 consecutive patients (61±10 years) undergoing FIRM guided ablation for persistent (n = 48), longstanding persistent (n = 7), or paroxysmal (n = 23) AF. AF recordings from both atria with a 64-pole basket catheter were analyzed using a novel mapping system (Rhythm ViewTM; Topera Inc., CA, USA). Identified rotors/focal sources were ablated, followed by PVI.Results: Each institution recruited a median of 6 patients, each of whom showed 2.3 ± 0.9 AF rotors/focal sources in diverse locations. 25.3% of all sources were right atrial (RA), and 50.0% of patients had ≥1 RA source. Ablation of all sources required a total of 16.6 ± 11.7 minutes, followed by PVI. On >1 year follow-up with a 3-month blanking period, 1 patient lost to follow-up (median time to 1st recurrence: 245 days, IQR 145-354), single-procedure freedom from AF was 87.5% (patients without prior ablation; 35/40) and 80.5% (all patients; 62/77) and similar for persistent and paroxysmal AF (P = 0.89).

AB - Multicenter FIRM Registry for AF. Introduction: The success of pulmonary vein isolation (PVI) for atrial fibrillation (AF) may be improved if stable AF sources identified by Focal Impulse and Rotor Mapping (FIRM) are also eliminated. The long-term results of this approach are unclear outside the centers where FIRM was developed; thus, we assessed outcomes of FIRM-guided AF ablation in the first cases at 10 experienced centers.Methods:We prospectively enrolled n=78 consecutive patients (61±10 years) undergoing FIRM guided ablation for persistent (n = 48), longstanding persistent (n = 7), or paroxysmal (n = 23) AF. AF recordings from both atria with a 64-pole basket catheter were analyzed using a novel mapping system (Rhythm ViewTM; Topera Inc., CA, USA). Identified rotors/focal sources were ablated, followed by PVI.Results: Each institution recruited a median of 6 patients, each of whom showed 2.3 ± 0.9 AF rotors/focal sources in diverse locations. 25.3% of all sources were right atrial (RA), and 50.0% of patients had ≥1 RA source. Ablation of all sources required a total of 16.6 ± 11.7 minutes, followed by PVI. On >1 year follow-up with a 3-month blanking period, 1 patient lost to follow-up (median time to 1st recurrence: 245 days, IQR 145-354), single-procedure freedom from AF was 87.5% (patients without prior ablation; 35/40) and 80.5% (all patients; 62/77) and similar for persistent and paroxysmal AF (P = 0.89).

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