Success in High-Risk Patients1
Cardiac ablation is one of many Afib treatment options. The authors hypothesized that comorbid conditions such as obesity, heart failure, obstructive sleep apnea (OSA), and enlarged left atria (LA) may cause higher numbers or non-PV (pulmonary vein) locations of atrial fibrillation (AF or Afib) sources, where targeted source ablation (focal impulse and rotor modulation or FIRM) could improve the single procedure success of ablation.
To determine if FIRM-guided rotor elimination improves single-procedure success in high-risk AF patients by reviewing a subset of patients from the Conventional Ablation of AF With or Without Focal Impulse and Rotor Modulation (CONFIRM)2 trial.
The CONFIRM trial prospectively enrolled 92 patients at 107 AF ablation heart procedures, in whom computational mapping identified AF rotors or focal sources. Patients underwent FIRM plus conventional ablation (FIRM-guided), or conventional ablation only, and were evaluated for recurrent AF quarterly with rigorous, often implanted monitoring. The authors reported the n = 73 patients undergoing first ablation in whom demographic information was available (n = 52 conventional, n = 21 FIRM-guided). The only exclusion was inability or refusal to provide written consent.
- Stable sources for AF were found in 97.1% of patients.
- The distribution of rotor locations was more widespread in high-risk patients (obese, OSA, persistent AF, heart failure).
- As compared to conventional PVI (pulmonary vein isolation) alone, FIRM-guided elimination of rotors significantly improved single-procedure success in patients with comorbidities including obesity, OSA, hypertension and patients with persistent AF.
- Baykaner T, Clopton P, Lalani GG, AA Schricker, Krummen DE, and Narayan SM. Targeted Ablation at Stable Atrial Fibrillation Sources Improves Success Over Conventional Ablation in High-Risk Patients: A Substudy of the CONFIRM Trial. Canadian J Cardiol. 2013; 29:1218-1226.
- Narayan SM, Krummen DE, Shivkumar K, Clopton P, Rappel W-J, and Miller JM. Treatment of Atrial Fibrillation by the Ablation of Localized Sources-CONFIRM (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation) Trial. J Am Coll Cardiol 2012; 60(7):628-3