Multicentre safety of adding Focal Impulse and Rotor Modulation (FIRM) to conventional ablation for atrial fibrillation

Krummen, David E.; Baykaner, Tina; Schricker, Amir; Kowalewski, Christopher; Swarup, Vijay; Miller, John M.; Tomassoni, Gery; Park, Shirley; Viswanathan, Mohan; Wang, Paul J.; Narayan, Sanjiv M.

doi:10.1093/europace/euw377

Cited by 18 publications

(13 citation statements)

References 21 publications

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“…In the STAR AF II trial, the placement of linear lesions and the ablation of complex fractionated electrograms did not result in better outcome compared with PVI alone in patients with persistent AF [32], and these results have been corroborated by subsequent publications [33,34]. Rotor mapping and ablation is a safe technique [35], but evidence regarding the associated benefits is also contradictory [36,37]. Substrate-based ablation with targeted ablation of low-voltage areas in the left atrium by placement of strategic lesions in addition to PVI seems to be promising, resulting in higher success rates compared with conventional strategies, as recently shown in a randomised comparison of these two approaches [38,39].…”

Section: Choice Of the Appropriate Techniquementioning

confidence: 82%

Catheter ablation of atrial fibrillation: current status, techniques, outcomes and challengesCatheter ablation of atrial fibrillation: current status, techniques, outcomes, and challenges

Hindricks¹,

Shamloo²,

Lenarczyk³

et al. 2018

Kardiol Pol

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Atrial fibrillation (AF) is the most common human arrhythmia. Interventional treatment with catheter ablation is an established technique that is increasingly applied and has become one of the main treatment modalities in patients with AF. Ablation results in significant improvement of symptoms and the quality of life. There is as yet no clear evidence of any impact of the procedure on hard clinical endpoints, except in patients with heart failure, who seem to benefit significantly from ablation. The cornerstone of the procedure is the achievement of pulmonary vein isolation. Radiofrequency energy is the main applied energy source, but cryoballoon ablation has emerged as a safe and effective alternative to radiofrequency ablation. Additional ablation strategies and novel technical features have been proposed but without unequivocal proof of clinical benefit. The most promising of these seems to be substrate mapping of the left atrium with substrate modification in areas with low voltage as an adjunct to pulmonary vein isolation. Complication rates remain considerable despite accumulated experience and can be partly reduced by application of preventive measures.

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Section: Choice Of the Appropriate Techniquementioning

confidence: 82%

Catheter ablation of atrial fibrillation: current status, techniques, outcomes and challengesCatheter ablation of atrial fibrillation: current status, techniques, outcomes, and challenges

Hindricks¹,

Shamloo²,

Lenarczyk³

et al. 2018

Kardiol Pol

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“…16 The fundamental mechanisms driving AF are still heavily debated by key opinion leaders because of the differences in pre-processing methods, analysis, and interpretation of fibrillation electrograms. 9,27 Currently proposed hypotheses are that AF is driven or sustained by focal activity emanating from varying locations throughout the atria; 9,28 spiral wave rotors that may change in complexity during the remodelling process 29,30 (also suggested by studies using ECG-imaging); 31 localized stable rotors [showed by using the Focal Impulse and Rotor Modulation (FIRM) approach]; 32,33 multiple wavelets in the three-dimensional architecture of the atrial wall. 20,34 In the context of AF ablation beyond PVI, AF sources are particularly interesting when they are stationary or preferentially occur at specific sites.…”

Section: Potential Applicationsmentioning

confidence: 99%

Incidence, prevalence, and trajectories of repetitive conduction patterns in human atrial fibrillation

et al. 2021

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Aims Repetitive conduction patterns in atrial fibrillation (AF) may reflect anatomical structures harbouring preferential conduction paths and indicate the presence of stationary sources for AF. Recently, we demonstrated a novel technique to detect repetitive patterns in high-density contact mapping of AF. As a first step towards repetitive pattern mapping to guide AF ablation, we determined the incidence, prevalence, and trajectories of repetitive conduction patterns in epicardial contact mapping of paroxysmal and persistent AF patients. Methods and results A 256-channel mapping array was used to record epicardial left and right AF electrograms in persistent AF (persAF, n = 9) and paroxysmal AF (pAF, n = 11) patients. Intervals containing repetitive conduction patterns were detected using recurrence plots. Activation movies, preferential conduction direction, and average activation sequence were used to characterize and classify conduction patterns. Repetitive patterns were identified in 33/40 recordings. Repetitive patterns were more prevalent in pAF compared with persAF [pAF: median 59%, inter-quartile range (41–72) vs. persAF: 39% (0–51), P < 0.01], larger [pAF: = 1.54 (1.15–1.96) vs. persAF: 1.16 (0.74–1.56) cm2, P < 0.001), and more stable [normalized preferentiality (0–1) pAF: 0.38 (0.25–0.50) vs. persAF: 0.23 (0–0.33), P < 0.01]. Most repetitive patterns were peripheral waves (87%), often with conduction block (69%), while breakthroughs (9%) and re-entries (2%) occurred less frequently. Conclusion High-density epicardial contact mapping in AF patients reveals frequent repetitive conduction patterns. In persistent AF patients, repetitive patterns were less frequent, smaller, and more variable than in paroxysmal AF patients. Future research should elucidate whether these patterns can help in finding AF ablation targets.

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“…Previous human in vivo research showed different strategies to locate AF drivers and guide pulmonary veins isolation (PVI). In the case of invasive mapping procedures (Narayan et al, 2012 ; Krummen et al, 2017 ; Navara et al, 2018 ), several catheters are introduced inside the atrial chambers to record from 8 to 128 simultaneous electrograms (EGM) (Narayan et al, 2012 ). Despite the number of intracardiac signals, the large distance between catheter sensors (up to 1–2 cm) and the complex atrial anatomy limits the capability of intracardiac mapping systems to characterize the global electrical activity in AF (Oesterlein et al, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

Non-invasive Estimation of Atrial Fibrillation Driver Position With Convolutional Neural Networks and Body Surface Potentials

et al. 2021

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Atrial fibrillation (AF) is characterized by complex and irregular propagation patterns, and AF onset locations and drivers responsible for its perpetuation are the main targets for ablation procedures. ECG imaging (ECGI) has been demonstrated as a promising tool to identify AF drivers and guide ablation procedures, being able to reconstruct the electrophysiological activity on the heart surface by using a non-invasive recording of body surface potentials (BSP). However, the inverse problem of ECGI is ill-posed, and it requires accurate mathematical modeling of both atria and torso, mainly from CT or MR images. Several deep learning-based methods have been proposed to detect AF, but most of the AF-based studies do not include the estimation of ablation targets. In this study, we propose to model the location of AF drivers from BSP as a supervised classification problem using convolutional neural networks (CNN). Accuracy in the test set ranged between 0.75 (SNR = 5 dB) and 0.93 (SNR = 20 dB upward) when assuming time independence, but it worsened to 0.52 or lower when dividing AF models into blocks. Therefore, CNN could be a robust method that could help to non-invasively identify target regions for ablation in AF by using body surface potential mapping, avoiding the use of ECGI.

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Multicentre safety of adding Focal Impulse and Rotor Modulation (FIRM) to conventional ablation for atrial fibrillation

Cited by 18 publications

References 21 publications

Catheter ablation of atrial fibrillation: current status, techniques, outcomes and challengesCatheter ablation of atrial fibrillation: current status, techniques, outcomes, and challenges

Catheter ablation of atrial fibrillation: current status, techniques, outcomes and challengesCatheter ablation of atrial fibrillation: current status, techniques, outcomes, and challenges

Incidence, prevalence, and trajectories of repetitive conduction patterns in human atrial fibrillation

Non-invasive Estimation of Atrial Fibrillation Driver Position With Convolutional Neural Networks and Body Surface Potentials

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