In people with non-paroxysmal atrial fibrillation , evidence suggests a superiority of RFCA to antiarrhythmic drugs in achieving freedom from atrial arrhythmias , reducing the need for cardioversion , and reducing cardiac-related hospitalisations .
BACKGROUND The optimal rhythm management strategy for people with non-paroxysmal ( persistent or long-st and ing persistent ) atrial fibrilation is currently not well defined .
Antiarrhythmic drugs have been the mainstay of therapy .
But recently , in people who have not responded to antiarrhythmic drugs , the use of ablation ( catheter and surgical ) has emerged as an alternative to maintain sinus rhythm to avoid long-term atrial fibrillation complications .
However , evidence from r and omised trials about the efficacy and safety of ablation in non-paroxysmal atrial fibrillation is limited .
OBJECTIVES To determine the efficacy and safety of ablation ( catheter and surgical ) in people with non-paroxysmal ( persistent or long-st and ing persistent ) atrial fibrillation compared to antiarrhythmic drugs .
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 )
In people with non-paroxysmal atrial fibrillation , evidence suggests a superiority of RFCA to antiarrhythmic drugs in achieving freedom from atrial arrhythmias , reducing the need for cardioversion , and reducing cardiac-related hospitalisations .
BACKGROUND The optimal rhythm management strategy for people with non-paroxysmal ( persistent or long-st and ing persistent ) atrial fibrilation is currently not well defined .
Antiarrhythmic drugs have been the mainstay of therapy .
But recently , in people who have not responded to antiarrhythmic drugs , the use of ablation ( catheter and surgical ) has emerged as an alternative to maintain sinus rhythm to avoid long-term atrial fibrillation complications .
However , evidence from r and omised trials about the efficacy and safety of ablation in non-paroxysmal atrial fibrillation is limited .
OBJECTIVES To determine the efficacy and safety of ablation ( catheter and surgical ) in people with non-paroxysmal ( persistent or long-st and ing persistent ) atrial fibrillation compared to antiarrhythmic drugs .