Benefits of Atrial Substrate Modification Guided by Electrogram Similarity and Phase Mapping Techniques to Eliminate Rotors and Focal Sources Versus Conventional Defragmentation in Persistent Atrial Fibrillation

Lin, Yenn‐Jiang; Lo, Men-Tzung; Chang, Shih‐Lin; Lo, Li‐Wei; Hu, Yu‐Feng; Chao, Tze‐Fan; Chung, Fa Po; Liao, Jo‐Nan; Lin, Chin‐Yu; Kuo, Hsien-Chang; Chang, Yi‐Chung; Lin, Chen; Tuan, Ta‐Chuan; Young, Hsu-Wen Vincent; Suenari, Kazuyoshi; Dan, Van Buu; Raharjo, Sunu Budhi; Huang, Norden E.; Chen, Shih‐Ann

doi:10.1016/j.jacep.2016.08.005

Cited by 49 publications

(105 citation statements)

References 24 publications

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“…Four studies reported a higher proportion of acute AF termination with driver‐guided ablation than in controls (pooled RR 2.08, 95% CI 1.43–3.05; P < 0.001), which increased to a RR 2.90 (95% CI 1.152–5.55, P = 0.001) when excluding patients undergoing driver‐guided ablation without concomitant PVI . Four studies suggested increased single‐procedure freedom from AF/AT at ≥1 year with driver‐guided ablation (RR 1.34, 95% CI 1.05–1.70; P = 0.02) though this was not significant when excluding cases of driver‐guided ablation without PVI (RR 1.41, 95% CI 0.96–2.08; P = 0.08) .…”

Section: Resultsmentioning

confidence: 96%

“…Four studies suggested increased single‐procedure freedom from AF/AT at ≥1 year with driver‐guided ablation (RR 1.34, 95% CI 1.05–1.70; P = 0.02) though this was not significant when excluding cases of driver‐guided ablation without PVI (RR 1.41, 95% CI 0.96–2.08; P = 0.08) . Five studies suggested greater freedom from AF at ≥1 year (RR 1.29, 95% CI 0.99–1.69; P = 0.06) . This RR increased to 1.39 (95% CI 1.01–1.90; P = 0.04) when restricted to freedom from AF/AT after a single procedure and to 1.52 (95% CI 1.07–2.17; P = 0.02) when excluding patients who underwent driver‐guided ablation without PVI (Fig.…”

Section: Resultsmentioning

confidence: 97%

“…). Two full RCTs were found . The remaining 29 reports were of nonrandomized or observational studies, predominantly cohort studies or case series.…”

Section: Resultsmentioning

confidence: 99%

“…Six studies with control groups reported relevant efficacy outcomes for both treatment and control groups (Table S5) . One study was excluded from this analysis as outcomes in patients with and without detectable rotors were reported, biasing comparisons of ablative approaches .…”

Section: Resultsmentioning

confidence: 99%

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Efficacy and safety of driver‐guided catheter ablation for atrial fibrillation: A systematic review and meta‐analysis

Ramirez

Birnie

Nair

et al. 2017

Cardiovasc electrophysiol

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Section: Resultsmentioning

confidence: 96%

Section: Resultsmentioning

confidence: 97%

“…). Two full RCTs were found . The remaining 29 reports were of nonrandomized or observational studies, predominantly cohort studies or case series.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy and safety of driver‐guided catheter ablation for atrial fibrillation: A systematic review and meta‐analysis

Ramirez

Birnie

Nair

et al. 2017

Cardiovasc electrophysiol

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“…Previous work is unclear on whether CFAE are strongly 5 or less strongly 28 associated with drivers. Recent work by Chen et al suggest that specific electrogram patterns of dominant frequency and kurtosis 29 , or electrogram dispersion 30 may mark AF driver sites.…”

Section: Discussionmentioning

confidence: 99%

Independent mapping methods reveal rotational activation near pulmonary veins where atrial fibrillation terminates before pulmonary vein isolation

Navara

Leef

Shenasa

et al. 2018

Cardiovasc electrophysiol

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OBJECTIVE To investigate mechanisms by which atrial fibrillation (AF) may terminate during ablation near the pulmonary veins before the veins are isolated (PVI). INTRODUCTION It remains unstudied how AF may terminate during ablation before PVs are isolated, or how patients with PV reconnection can be arrhythmia-free. We studied patients in whom PV antral ablation terminated AF before PVI, using 2 independent mapping methods. METHODS We studied patients with AF referred for ablation, in whom bi-atrial contact basket electrograms were studied by both an activation/phase mapping method and by a second validated mapping method reported not to create false rotational activity. RESULTS In 22 patients (age 60.1±10.4, 36% persistent AF), ablation at sites near the PVs terminated AF (77% to sinus rhythm) prior to PVI. AF propagation revealed rotational (n=20) and focal (n=2) patterns at sites of termination by mapping method 1 and method 2. Both methods showed organized sites that were spatially concordant (p<0.001) with similar stability (p<0.001). Vagal slowing was not observed at sites of AF termination. DISCUSSION PV antral regions where ablation terminated AF before PVI exhibited rotational and focal activation by two independent mapping methods. These data provide an alternative mechanism for the success of PVI, and may explain AF termination before PVI or lack of arrhythmias despite PV reconnection. Mapping such sites may enable targeted PV lesion sets and improved freedom from AF.

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Catheter Ablation With Morphologic Repetitiveness Mapping for Persistent Atrial Fibrillation

Lin,

Higa

et al. 2023

JAMA Netw Open

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ImportanceCatheter ablation for persistent atrial fibrillation (AF) has shown limited success.ObjectiveTo determine whether AF drivers could be accurately identified by periodicity and similarity (PRISM) mapping ablation results for persistent AF when added to pulmonary vein isolation (PVI).Design, Setting, and ParticipantsThis prospective randomized clinical trial was performed between June 1, 2019, and December 31, 2020, and included patients with persistent AF enrolled in 3 centers across Asia. Data were analyzed on October 1, 2022.InterventionPatients were assigned to the PRISM-guided approach (group 1) or the conventional approach (group 2) at a 1:1 ratio.Main Outcomes and MeasuresThe primary outcome was freedom from AF or other atrial arrhythmia for longer than 30 seconds at 6 and 12 months.ResultsA total of 170 patients (mean [SD] age, 62.0 [12.3] years; 136 men [80.0%]) were enrolled (85 patients in group 1 and 85 patients in group 2). More group 1 patients achieved freedom from AF at 12 months compared with group 2 patients (60 [70.6%] vs 40 [47.1%]). Multivariate analysis indicated that the PRISM-guided approach was associated with freedom from the recurrence of atrial arrhythmia (hazard ratio, 0.53 [95% CI, 0.33-0.85]).Conclusions and RelevanceThe waveform similarity and recurrence pattern derived from high-density mapping might provide an improved guiding approach for ablation of persistent AF. Compared with the conventional procedure, this novel specific substrate ablation strategy reduced the frequency of recurrent AF and increased the likelihood of maintenance of sinus rhythm.Trial RegistrationClinicalTrials.gov Identifier: NCT05333952

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Benefits of Atrial Substrate Modification Guided by Electrogram Similarity and Phase Mapping Techniques to Eliminate Rotors and Focal Sources Versus Conventional Defragmentation in Persistent Atrial Fibrillation

Abstract: Our study showed that for persistent AF ablation, a specified substrate modification guided by nonlinear phase mapping could eliminate localized re-entry and non-pulmonary focal sources after pulmonary vein isolation.

Cited by 49 publications

References 24 publications

Efficacy and safety of driver‐guided catheter ablation for atrial fibrillation: A systematic review and meta‐analysis

Efficacy and safety of driver‐guided catheter ablation for atrial fibrillation: A systematic review and meta‐analysis

Independent mapping methods reveal rotational activation near pulmonary veins where atrial fibrillation terminates before pulmonary vein isolation

Catheter Ablation With Morphologic Repetitiveness Mapping for Persistent Atrial Fibrillation

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