Direct or coincidental elimination of stable rotors or focal sources may explain successful atrial fibrillation ablation: on-treatment analysis of the CONFIRM trial (Conventional ablation for AF with or without focal impulse and rotor modulation).
Direct or coincidental elimination of stable rotors or focal sources may explain successful atrial fibrillation ablation: on-treatment analysis of the CONFIRM trial (Conventional ablation for AF with or without focal impulse and rotor modulation).
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稳定转子或焦点源的直接或巧合消除可能解释了成功的房颤消融：确认试验的对治疗分析（对AF的常规消融有或没有局灶性脉冲脉冲和转子调制）。
DOI：
10.1016/j.jacc.2013.03.021
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发表时间：
2013-07-09
影响因子：
24
通讯作者：
Miller, John M.
中科院分区：
文献类型：
--
作者：
Narayan, Sanjiv M.;Krummen, David E.;Clopton, Paul;Shivkumar, Kalyanam;Miller, John M.
我们假设，最近描述的稳定的AF源的消融，无论是直接通过局灶脉冲和转子调制（FIRM）或巧合时，解剖消融通过AF源，可以解释AF的长期自由。目前还不清楚为什么传统的解剖AF消融可以在一些患者非常有效，但在其他类似的配置文件无效。CONFIRM试验前瞻性显示，在107例连续消融病例中，98/101例AF受试者的AF转子或局灶源稳定。以1：2的方式，受试者接受靶向源消融（FIRM），然后接受常规消融，或仅接受常规消融。我们确定电解剖标测图上的消融病变是否通过FIRM标测图上的AF源。完成随访的受试者（n=94，71.2%持续性AF）均显示2.3±1.1个并发AF转子或局灶性源，位于肺静脉附近（22.8%）、左心房顶部（16.0%）以及左心房（28.2%）和右心房（33.0%）的其他位置。在100%的FIRM病例中直接消融AF源，在45%的常规病例中偶然消融（例如左心房顶部）（p<0.05）。在1次手术后的273天（中位数，IQR 138-636）内，如果源被消融，则80.3%的患者不存在AF，但如果源被遗漏，则81.8%的患者复发（p<0.001）。如果所有源都被消融，则无AF的比率最高，如果一些源被消融，则居中，如果没有源被消融，则最低（p<0.001）。消除稳定的AF转子和局灶源可以解释不同消融方法后无AF的原因。患者特异性房颤源分布与报告的特定解剖学病变集和广泛消融的成功一致。这些结果支持靶向AF源以减少不必要的消融，并激励仅FIRM消融的研究。
We hypothesized that ablation of recently described stable AF sources, either directly by Focal Impulse and Rotor Modulation (FIRM) or coincidentally when anatomical ablation passes through AF sources, may explain long term freedom of AF. It is unclear why conventional anatomical AF ablation can be very effective in some patients yet ineffective in others with similar profiles. The CONFIRM trial prospectively revealed stable AF rotors or focal sources in 98/101 subjects with AF at 107 consecutive ablation cases. In 1:2 fashion, subjects received targeted source ablation (FIRM) then conventional ablation, or conventional ablation alone. We determined if ablation lesions on electroanatomic maps passed through AF sources on FIRM maps. Subjects who completed followup (n=94, 71.2% persistent AF) each showed 2.3±1.1 concurrent AF rotors or focal sources, that lay near pulmonary veins (22.8%), left atrial roof (16.0%), and elsewhere in left (28.2%) and right (33.0%) atria. AF sources were ablated directly in 100% FIRM cases and coincidentally (e.g. left atrial roof) in 45% conventional cases (p<0.05). During 273 days (median, IQR 138–636) after 1 procedure, AF was absent in 80.3% of patients if sources were ablated but recurred in 81.8% of patients if sources were missed (p<0.001). Freedom from AF was highest if all sources were ablated, intermediate if some sources were ablated, and lowest if no sources were ablated (p<0.001). Elimination of stable AF rotors and focal sources may explain freedom from AF after diverse approaches to ablation. Patient-specific AF source distributions are consistent with the reported success of specific anatomical lesion sets, and of widespread ablation. These results support targeting AF sources to reduce unnecessary ablation, and motivate studies on FIRM-only ablation.
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影响因子：
3.7
作者：
Narayan, Sanjiv M.;Krummen, David E.;Rappel, Wouter-Jan
通讯作者：
Rappel, Wouter-Jan
影响因子：
5.5
作者：
Narayan, Sanjiv M.;Patel, Jigar;Krummen, David E.
通讯作者：
Krummen, David E.
影响因子：
24
作者：
Narayan, Sanjiv M.;Krummen, David E.;Miller, John M.
通讯作者：
Miller, John M.
DOI：
10.1111/j.1540-8167.2012.02332.x
发表时间：
2012-05-01
影响因子：
2.7
作者：
Narayan, Sanjiv M.;Krummen, David E.;Rappel, Wouter-Jan
通讯作者：
Rappel, Wouter-Jan
影响因子：
6.1
作者：
Calvo, David;Atienza, Felipe;Berenfeld, Omer
通讯作者：
Berenfeld, Omer