Poor Outcomes with FIRM-ablation Alone in Non-Paroxysmal Atrial Fibrillation

MedicalResearch.com Interview with:
Sanghamitra Mohanty, MD MS FHRS
Director, translational research, Texas Cardiac Arrhythmia Institute and Associate Professor (affiliate) Dell Medical School

MedicalResearch.com: What is the background for this study?

Dr. Mohanty: In patients with atrial fibrillation, Focal Impulse and Rotor Modulation (FIRM)-ablation alone or in combination with pulmonary vein (PV) isolation has been documented to possibly be a better alternative to PV isolation only. However, none of those trials had a randomized study design. The current study was the first attempt to compare 3 ablation strategies namely FIRM ablation alone (group 1), FIRM +PV isolation (group 2) and PV isolation combined with ablation of non-PV triggers (group 3) in a randomized controlled trial in persistent and long-standing persistent AF.

MedicalResearch.com: What are the main findings?

Dr. Mohanty: Our main findings were the following:

1)      Procedure time was significantly shorter in group 3 (no FIRM ablation) compared to group 1 and 2 (with FIRM ablation)

2)      FIRM-ablation alone had very poor outcome in terms of arrhythmia recurrence (86%)

3)      FIRM ablation plus PV isolation had significantly longer procedure time and lower efficacy than PV isolation + non-PV trigger-ablation (52.4% vs 76%, p=0.02).

MedicalResearch.com: What should readers take away from your report?

Dr. Mohanty: In non-paroxysmal atrial fibrillation patients, ablation of the electrical rotors and focal impulses only is of little use and pulmonary vein (PV) isolation plus ablation of rotors is not sufficient to achieve durable arrhythmia-free survival.

However, success rate was significantly higher with extensive PV isolation combined with ablation of non-PV triggers. Thus, in this subset of AF population, beyond PVAI operators need to identify and target extra-PV triggers to maximize procedural success

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Mohanty: More randomized controlled trials on larger populations with implantable loop recorders for continuous arrhythmia-monitoring would be helpful in determining optimal strategies that are relevant and effective in increasing the success rate of catheter ablation in the non-paroxysmal atrial fibrillation population.

MedicalResearch.com: Is there anything else you would like to add?

Dr. Mohanty: It is not yet clear if the low efficacy of the current FIRM-mapping technology is due to its sub-optimal ability to identify pertinent rotors or the rotors are not so relevant in maintaining atrial fibrillation after all. Therefore, the FIRM-approach needs further validation before it is adopted widely in clinical practice.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Abstract presented at the 2016 Heart Rhythm Society

LBCT02-01 / LBCT02-01 – Impact of rotor ablation in non-paroxysmal AF patients: results from a randomized trial (OASIS)

Andrea Natale, MD, FHRS, Sanghamitra Mohanty, MD, FHRS, Carola Gianni, MD, Philipp Halbfass, MD, Prasant Mohanty, MD, MPH, Tamara Metz, RN, BSN, Chintan Trivedi, MD, MPH, Thomas Deneke, MD, PhD, Gery F. Tomassoni, MD, FHRS, Rong Bai, MD, Amin Al-Ahmad, MD, FHRS, Shane Bailey, MD, John D. Burkhardt, MD, FHRS, G. Joseph Gallinghouse, MD, Rodney P. Horton, MD, Patrick Hranitzky, MD, FHRS, Javier E. Sanchez, MD and Luigi Di Biase. Texas Cardiac Arrhythmia Institute, Austin, TX, St. David’s Medical Center, Austin, TX, Dipartimento di Scienze Cliniche e di Comunità, Milano, Italy, Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin, TX, Heartcenter Bad Neustadt, Bad Neustadt, Germany, Lexington Cardiology Consultants, Lexington, KY, Beijing Anzhen Hospital, Beijing, China, Texas Cardiac Arrhythmia Research, Austin, TX, Texas Cardiac Arrhythmia Institute at St. David’s Medical Center and Albert Einstein College of Medicine at Montefiore Hospital, Austin, TX 

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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