A PVI-only strategy in PeAF patients with a low prevalence of structural heart disease using contemporary technology yields excellent outcomes comparable to those for paroxysmal AF ablation
BACKGROUND Early studies demonstrated relatively low success rates for pulmonary vein isolation ( PVI ) alone in patients with persistent atrial fibrillation ( PeAF ) .
However , the advent of new technologies and the observation that additional substrate ablation does not improve outcomes have created a new focus on PVI alone for treatment of PeAF .
OBJECTIVE The purpose of this study was to systematic ally review the recent medical literature to determine current medium-term outcomes when a PVI-only approach is used for PeAF .
Focal impulse and rotor modulation: Acute procedural observations and extended clinical follow-up.
BACKGROUND Focal impulse and rotor modulation ( FIRM ) was based on the premise that atrial fibrillation ( AF ) is sustained by rotors that are sufficiently stable to be eliminated by targeted ablation . Early experience reported high success as compared to conventional strategies . OBJECTIVE The purpose of this study was to report on a single-center experience with extended follow-up by using FIRM in a variety of patients with AF . METHODS All FIRM-guided ablation procedures were included . During spontaneous or induced AF , FIRM software constructed phase maps to identify putative AF sources , then targeted for radiofrequency ablation , with adjunctive pulmonary vein isolation ( PVI ) , if needed . All mapped rotors and /or sources were eliminated on the basis of repeated FIRM mapping . RESULTS Of 47 patients , sustained AF was not present or induced in 4 patients who did not undergo FIRM ablation . Of the remaining 43 patients , prior AF was paroxysmal in 9 ( 21 % ) and 72 % had a median of 1 prior PVI . Spontaneous AF ( n = 22 , 52 % ) and induced AF ( n = 21 , 49 % ) were mapped , and all patients had rotors identified ( 1.8 ± 0.8 per patient ; 70 % in the left atrium ) . AF termination occurred in 2 patients ( 5 % ) and none organized to atrial tachycardia . Touch-up redo PVI was also performed in 31 patients ( 72 % ) . At 16.0 ± 10.7 months ( range 1 - 34 months ) , only 9 patients ( 21 % ) were free of recurrent AF ; and only 5 patients ( 12 % ) were free of AF and off antiarrhythmic drugs . CONCLUSION Long-term clinical results after FIRM ablation in this diverse challenging cohort showed poor efficacy . R and omized clinical trials are needed to evaluate the efficacy and clinical utility of the FIRM ablation approach for treating AF
A PVI-only strategy in PeAF patients with a low prevalence of structural heart disease using contemporary technology yields excellent outcomes comparable to those for paroxysmal AF ablation
BACKGROUND Early studies demonstrated relatively low success rates for pulmonary vein isolation ( PVI ) alone in patients with persistent atrial fibrillation ( PeAF ) .
However , the advent of new technologies and the observation that additional substrate ablation does not improve outcomes have created a new focus on PVI alone for treatment of PeAF .
OBJECTIVE The purpose of this study was to systematic ally review the recent medical literature to determine current medium-term outcomes when a PVI-only approach is used for PeAF .