Where data were available , the relative benefits seen held true both after a single or multiple procedure(s ) .
For patients with persistent atrial fibrillation , CA achieves significantly greater freedom from recurrent atrial fibrillation compared with medical therapy .
BACKGROUND Catheter ablation ( CA ) is commonly performed for persistent atrial fibrillation , but few high- quality r and omized controlled trials ( RCTs ) exist , leading to funding restrictions being proposed in several countries .
We performed a r and om-effects meta- analysis of RCTs and non- RCTs to assess the efficacy of CA for persistent atrial fibrillation .
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.
OBJECTIVES We hypothesized that human atrial fibrillation ( AF ) may be sustained by localized sources ( electrical rotors and focal impulses ) , whose elimination ( focal impulse and rotor modulation [ FIRM ] ) may improve outcome from AF ablation . BACKGROUND Catheter ablation for AF is a promising therapy , whose success is limited in part by uncertainty in the mechanisms that sustain AF . We developed a computational approach to map whether AF is sustained by several me and ering waves ( the prevailing hypothesis ) or localized sources , then prospect ively tested whether targeting patient-specific mechanisms revealed by mapping would improve AF ablation outcome . METHODS We recruited 92 subjects during 107 consecutive ablation procedures for paroxysmal or persistent ( 72 % ) AF . Cases were prospect ively treated , in a 2-arm 1:2 design , by ablation at sources ( FIRM-guided ) followed by conventional ablation ( n = 36 ) , or conventional ablation alone ( n = 71 ; FIRM-blinded ) . RESULTS Localized rotors or focal impulses were detected in 98 ( 97 % ) of 101 cases with sustained AF , each exhibiting 2.1 ± 1.0 sources . The acute endpoint ( AF termination or consistent slowing ) was achieved in 86 % of FIRM-guided cases versus 20 % of FIRM-blinded cases ( p < 0.001 ) . FIRM ablation alone at the primary source terminated AF in a median 2.5 min ( interquartile range : 1.0 to 3.1 min ) . Total ablation time did not differ between groups ( 57.8 ± 22.8 min vs. 52.1 ± 17.8 min , p = 0.16 ) . During a median 273 days ( interquartile range : 132 to 681 days ) after a single procedure , FIRM-guided cases had higher freedom from AF ( 82.4 % vs. 44.9 % ; p < 0.001 ) after a single procedure than FIRM-blinded cases with rigorous , often implanted , electrocardiography monitoring . Adverse events did not differ between groups . CONCLUSIONS Localized electrical rotors and focal impulse sources are prevalent sustaining mechanisms for human AF . FIRM ablation at patient-specific sources acutely terminated or slowed AF , and improved outcome . These results offer a novel mechanistic framework and treatment paradigm for AF . ( Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation [ CONFIRM ] ; NCT01008722 )
Where data were available , the relative benefits seen held true both after a single or multiple procedure(s ) .
For patients with persistent atrial fibrillation , CA achieves significantly greater freedom from recurrent atrial fibrillation compared with medical therapy .
BACKGROUND Catheter ablation ( CA ) is commonly performed for persistent atrial fibrillation , but few high- quality r and omized controlled trials ( RCTs ) exist , leading to funding restrictions being proposed in several countries .
We performed a r and om-effects meta- analysis of RCTs and non- RCTs to assess the efficacy of CA for persistent atrial fibrillation .