Initial independent outcomes from focal impulse and rotor modulation ablation for atrial fibrillation: multicenter FIRM registry.
Initial independent outcomes from focal impulse and rotor modulation ablation for atrial fibrillation: multicenter FIRM registry.
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DOI：
10.1111/jce.12474
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发表时间：
2014-09
影响因子：
2.7
通讯作者：
Wheelan KR
中科院分区：
文献类型：
--
作者：
Miller JM;Kowal RC;Swarup V;Daubert JP;Daoud EG;Day JD;Ellenbogen KA;Hummel JD;Baykaner T;Krummen DE;Narayan SM;Reddy VY;Shivkumar K;Steinberg JS;Wheelan KR
如果消除了通过局灶脉冲和转子标测（FIRM）识别的稳定房颤源，则肺静脉隔离（PVI）治疗房颤（AF）的成功率可能会提高。在开发FIRM的中心之外，这种方法的长期结果尚不清楚;因此，我们在10家经验丰富的中心评估了FIRM引导的房颤消融的首批病例的结局。我们前瞻性地招募了n = 78名连续患者（61 ± 10岁），这些患者接受了FIRM引导的消融术，以治疗持续性（n = 48）、长期持续性（n = 7）或阵发性（n = 23）AF。使用新型标测系统（Rhythm View™; Topera Inc.，美国加利福尼亚州）。消融识别出的转子/局灶源，然后进行肺静脉隔离。每家机构招募了6名患者（中位数），每名患者在不同位置显示2.3 ± 0.9个AF转子/局灶源。25.3%的患者有右心房（RA），50.0%的患者有≥1个RA源。所有源的消融总共需要16.6 ± 11.7分钟，然后进行肺静脉隔离。在>1年随访（3个月空白期）时，1例患者失访（至首次复发的中位时间：245天，IQR 145-354），单次手术无AF率为87.5%（既往未消融的患者; 35/40）和80.5%（所有患者; 62/77），持续性和阵发性AF相似（P = 0.89）。在FIRM的新中心，消除患者特异性AF转子/局灶源后，1年时无AF率> 80%。FIRM引导的消融具有快速的学习曲线，在每个中心的第一个病例中产生与原始FIRM报告相似的结果。
The success of pulmonary vein isolation (PVI) for atrial fibrillation (AF) may be improved if stable AF sources identified by Focal Impulse and Rotor Mapping (FIRM) are also eliminated. The long-term results of this approach are unclear outside the centers where FIRM was developed; thus, we assessed outcomes of FIRM-guided AF ablation in the first cases at 10 experienced centers. We prospectively enrolled n = 78 consecutive patients (61 ± 10 years) undergoing FIRM guided ablation for persistent (n = 48), longstanding persistent (n = 7), or paroxysmal (n = 23) AF. AF recordings from both atria with a 64-pole basket catheter were analyzed using a novel mapping system (Rhythm View™; Topera Inc., CA, USA). Identified rotors/focal sources were ablated, followed by PVI. Each institution recruited a median of 6 patients, each of whom showed 2.3 ± 0.9 AF rotors/focal sources in diverse locations. 25.3% of all sources were right atrial (RA), and 50.0% of patients had ≥1 RA source. Ablation of all sources required a total of 16.6 ± 11.7 minutes, followed by PVI. On >1 year follow-up with a 3-month blanking period, 1 patient lost to follow-up (median time to 1st recurrence: 245 days, IQR 145–354), single-procedure freedom from AF was 87.5% (patients without prior ablation; 35/40) and 80.5% (all patients; 62/77) and similar for persistent and paroxysmal AF (P = 0.89). Elimination of patient-specific AF rotors/focal sources produced freedom-from-AF of ≈80% at 1 year at centers new to FIRM. FIRM-guided ablation has a rapid learning curve, yielding similar results to original FIRM reports in each center’s first cases.
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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）。
影响因子：
24
作者：
Narayan, Sanjiv M.;Krummen, David E.;Clopton, Paul;Shivkumar, Kalyanam;Miller, John M.
通讯作者：
Miller, John M.
影响因子：
37.8
作者：
GERSTENFELD, EP;SAHAKIAN, AV;SWIRYN, S
通讯作者：
SWIRYN, S
影响因子：
24
作者：
Narayan, Sanjiv M.;Krummen, David E.;Miller, John M.
通讯作者：
Miller, John M.
影响因子：
37.8
作者：
Oral, Hakan;Chugh, Aman;Morady, Fred
通讯作者：
Morady, Fred
影响因子：
3.7
作者：
Narayan, Sanjiv M.;Krummen, David E.;Rappel, Wouter-Jan
通讯作者：
Rappel, Wouter-Jan