CONFIRM Trial Extended Follow-Up 1
The aim of this study was to determine if coronary ablation procedures that target patient-specific atrial fibrillation (AF)-sustaining substrates known as rotors or focal sources, is more durable than trigger ablation alone at preventing late AF recurrence.
Late recurrence substantially limits the efficacy of pulmonary vein isolation (PVI) for AF and is associated with pulmonary vein reconnection and the emergence of new triggers.
The study was a 3 year follow-up of the CONFIRM (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation) trial2, in which 92 consecutive patients with AF (70.7% persistent) underwent novel computational mapping. Ablation comprised source (focal impulse and rotor modulation or FIRM) and then conventional ablation in 27 patients (FIRM-guided) and conventional ablation alone in 65 patients (FIRM-blinded). Patients were followed with implanted electrocardiographic monitors when possible (85.2% of FIRM-guided patients, 23.1% of FIRM-blinded patients).
FIRM-guided ablation is more durable than conventional trigger-based cardiac ablation procedures in preventing 3-year AF recurrence. The authors recommended that future studies should investigate how ablation of patient-specific AF-sustaining rotors and focal sources alters the natural history of arrhythmia patients.
- Narayan SM, Baykaner T, Clopton P, Schricker A, Lalani G, Krummen DE, Shivkumar K, Miller JM, Ablation of Rotor and Focal Sources Reduces Late Recurrence of Atrial Fibrillation Compared to Trigger Ablation Alone, J Am Coll of Cardiol (2014), doi: 10.1016/j.jacc.2014.02.543.
- 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