Repeat pulmonary vein isolation with or without FIRM‐guided ablation for recurrent atrial fibrillation with pulmonary vein reconnection

Peigh, Graham; Wasserlauf, Jeremiah; Kaplan, Rachel; Amaral, Ansel P.; Trivedi, Amar; Chicos, Alexandru B.; Arora, Rishi; Kim, Susan; Lin, Albert; Verma, Nishant; Knight, Bradley P.; Passman, Rod

doi:10.1111/jce.14426

Cited by 11 publications

(12 citation statements)

References 27 publications

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“…Pooled data from three studies (OASIS, FIRMAP AF, and Peigh et al 9 ) did not reveal a statistically significant difference in complication rates between FIRM‐guided ablation ± PVI and PVI (RR: 1.66; 95% CI: 0.08–34.54; p = .74) (Figure 6).…”

Section: Resultsmentioning

confidence: 95%

“…In CONFIRM trial, consecutive cases were prospectively enrolled in a 1:2 case cohort design of FIRM‐guided ablation versus PVI 1 . The two remaining studies by Kirzner et al 8 and Peigh et al 9 were retrospective studies.…”

Section: Resultsmentioning

confidence: 99%

“…Of the 674 included patients, 297 underwent FIRM‐guided ablation ± PVI, and the remaining 377 patients underwent PVI. Three studies (CONFIRM, Peigh et al, 9 Kirzner et al 8 ) were observational studies that enrolled a total of 261 patients, with a mean follow‐up duration of 28 months 1,8,9 . The other three studies (OASIS, FIRMAP AF, REAFFIRM) were RCTs that enrolled a total of 413 patients, with a mean follow‐up duration of 13.5 months 5–7 .…”

Section: Resultsmentioning

confidence: 99%

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Focal impulse and rotor modulation guided ablation versus pulmonary vein isolation for atrial fibrillation: A meta‐analysis of head‐to‐head comparative studies

Romero

Gabr

Briceño

et al. 2021

Cardiovasc electrophysiol

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Introduction Empirical pulmonary vein isolation (PVI) remains the cornerstone for catheter ablation of atrial fibrillation (AF). Various ablation strategies and modalities are continually tested with the aim of improving ablation outcomes. Although focal impulse and rotor modulation (FIRM)‐guided ablation is currently used as an adjunct to PVI, evidence supporting this strategy is conflicting. We sought to examine whether the utilization of FIRM‐guided ablation with or without PVI is associated with a decrease in all‐atrial arrhythmia recurrence as compared to PVI alone. Methods A systematic review of PubMed, Cochrane, and Embase was performed for head‐to‐head study designs comparing outcomes of patients who underwent FIRM‐guided ablation with or without PVI to those who underwent PVI alone. The primary efficacy endpoint was all‐atrial arrhythmia recurrence. The secondary endpoints were complications rates and procedural characteristics. Results Overall, six studies comprising 674 patients undergoing either FIRM‐guided ablation ± PVI versus PVI were included (mean age 63.4 ± 9.2, male 74%, 9% paroxysmal AF, 91% nonparoxysmal AF). After a mean follow‐up of 18.8 months, FIRM‐guided ablation with or without PVI was not associated with improvement in all‐atrial arrhythmia recurrence rate compared to PVI alone (43.4% vs. 45.9%, risk ratio [RR]: 1.06; 95% confidence interval [CI]: 0.77–1.47; p = .70). No statistically significant difference was noted in complication rates between the two groups (RR: 1.66; 95% CI: 0.08–34.54; p = .74). Conclusion In this meta‐analysis of head‐to‐head comparison studies, FIRM‐guided ablation with or without PVI did not provide any benefit in improving all‐atrial arrhythmia recurrence at follow‐up when compared to PVI alone.

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Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Focal impulse and rotor modulation guided ablation versus pulmonary vein isolation for atrial fibrillation: A meta‐analysis of head‐to‐head comparative studies

Romero

Gabr

Briceño

et al. 2021

Cardiovasc electrophysiol

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“…The CBA procedural protocol used in this study has been published previously. 5,15 All procedures were performed by board certified electrophysiologists with extensive ablation experience. Briefly, after transeptal catheterization, an Arctic Front Advance (Medtronic Inc.) cryoballoon catheter and Achieve catheter (Medtronic Inc.) were introduced into the left atrium (LA) using the FlexCath Advance Steerable Sheath (Medtronic Inc.).…”

Section: Procedural Detailsmentioning

confidence: 99%

Impact of pre‐ablation weight loss on the success of catheter ablation for atrial fibrillation

Peigh

Wasserlauf

Vogel

et al. 2021

Cardiovasc electrophysiol

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Introduction: Obesity is an established risk factor for recurrent atrial fibrillation (AF) after ablation. The impact of pre-procedure weight changes on freedom from AF (FFAF) after ablation in obese and nonobese patients is unknown.Methods: A single-center retrospective cohort study of patients undergoing pulmonary vein isolation was performed. Before ablation, all candidates were encouraged to adopt healthy lifestyle habits according to American Heart Association guidelines, including weight loss, by their physician. The primary endpoint was FFAF through 1-year after completion of the 3-month blanking period.Results: Of the 601 patients (68% male; average age 62.1 ± 10.3 years) included in analysis, 234 patients (38.9%) were obese (body mass index ≥ 30) and 315 (52.4%) had paroxysmal AF. FFAF was observed in 420 patients (69.9%) at 15 months. Percent change in weight that occurred during the year before ablation independently predicted FFAF through 15-months in all patients (adjusted odds ratio = 1.17, 95% confidence interval: 1.11-1.23). Subgroup analyses based on paroxysmal vs persistent AF, presence of obesity, and history of prior ablation were performed. Percent change in weight over the year before ablation was independently associated with FFAF in all subgroups except nonobese patients with persistent AF. Conclusion:Pre-ablation weight loss was associated with FFAF in both obese and nonobese patients. Further studies are needed to define the optimal approach to weight loss before AF ablation.

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“…Fig 5. Demonstration of a local efficiency curve simulating from a clinical AF map (Subject 841-004, Sarkozy et al 2020[25]), which could be integrated into CARTOFINDER rotational activity analysis interface in the Carto 3 mapping system.…”

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confidence: 99%

Atrial fibrillation driver identification through regional mutual information networks: a modeling perspective

Sha¹,

Elliott²,

Zhang³

et al. 2022

J Interv Card Electrophysiol

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Purpose Effective identification of electrical drivers within remodeled tissue is a key for improving ablation treatment for atrial fibrillation. We have developed a mutual information, graph-based approach to identify and propose fault tolerance metric of local efficiency as a distinguishing feature of rotational activation and remodeled atrial tissue. Methods Voltage data were extracted from atrial tissue simulations (2D Karma, 3D physiological, and the Multiscale Cardiac Simulation Framework (MSCSF)) using multi-spline open and parallel regional mapping catheter geometries. Graphs were generated based on varied mutual information thresholds between electrode pairs and the local efficiency for each graph was calculated. Results High-resolution mapping catheter geometries can distinguish between rotational and irregular activation patterns using the derivative of local efficiency as a function of increasing mutual information threshold. The derivative is decreased for rotational activation patterns comparing to irregular activations in both a simplified 2D model (0.0017 ± 1 × 10−4 vs. 0.0032 ± 1 × 10−4, p < 0.01) and a more realistic 3D model (0.00092 ± 5 × 10−5 vs. 0.0014 ± 4 × 10−5, p < 0.01). Average local efficiency derivative can also distinguish between degrees of remodeling. Simulations using the MSCSF model, with 10 vs. 90% remodeling, display distinct derivatives in the grid design parallel spline catheter configuration (0.0015 ± 5 × 10−5 vs. 0.0019 ± 6 × 10−5, p < 0.01) and the flower shaped open spline configuration (0.0011 ± 5 × 10−5 vs. 0.0016 ± 4 × 10−5, p < 0.01). Conclusion A decreased derivative of local efficiency characterizes rotational activation and varies with atrial remodeling. This suggests a distinct communication pattern in cardiac rotational activation detectable via high-resolution regional mapping and could enable identification of electrical drivers for targeted ablation.

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Repeat pulmonary vein isolation with or without FIRM‐guided ablation for recurrent atrial fibrillation with pulmonary vein reconnection

Cited by 11 publications

References 27 publications

Focal impulse and rotor modulation guided ablation versus pulmonary vein isolation for atrial fibrillation: A meta‐analysis of head‐to‐head comparative studies

Focal impulse and rotor modulation guided ablation versus pulmonary vein isolation for atrial fibrillation: A meta‐analysis of head‐to‐head comparative studies

Impact of pre‐ablation weight loss on the success of catheter ablation for atrial fibrillation

Atrial fibrillation driver identification through regional mutual information networks: a modeling perspective

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