Impact of Rotor Ablation in Nonparoxysmal Atrial Fibrillation Patients: Results From the Randomized OASIS Trial

Nonrandomized studies have reported focal impulse and rotor modulation (FIRM)-guided ablation to be superior to pulmonary vein antrum isolation (PVAI) for persistent atrial fibrillation and long-standing persistent atrial fibrillation. This study sought to compare efficacy of FIRM ablation with or w...

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Published in:Journal of the American College of Cardiology 2016-07, Vol.68 (3), p.274-282
Main Authors: Mohanty, Sanghamitra, Gianni, Carola, Mohanty, Prasant, Halbfass, Philipp, Metz, Tamara, Trivedi, Chintan, Deneke, Thomas, Tomassoni, Gery, Bai, Rong, Al-Ahmad, Amin, Bailey, Shane, Burkhardt, John David, Gallinghouse, G Joseph, Horton, Rodney, Hranitzky, Patrick M, Sanchez, Javier E, Di Biase, Luigi, Natale, Andrea
Format: Article
Language:English
Subjects:
Anticoagulants
Cardiac arrhythmia
Cardiology
Catheters
Drugs
Patients
Success
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Summary:Nonrandomized studies have reported focal impulse and rotor modulation (FIRM)-guided ablation to be superior to pulmonary vein antrum isolation (PVAI) for persistent atrial fibrillation and long-standing persistent atrial fibrillation. This study sought to compare efficacy of FIRM ablation with or without PVAI versus PVAI plus non-PV trigger ablation in randomized persistent atrial fibrillation and long-standing persistent atrial fibrillation patients. Nonparoxysmal atrial fibrillation (AF) patients undergoing first ablation were randomized to FIRM only (group 1), FIRM + PVAI (group 2) or PVAI + posterior wall + non-PV trigger ablation (group 3). Primary endpoint was freedom from atrial tachycardia/AF. The secondary endpoint was acute procedural success, defined as AF termination, ≥10% slowing, or organization into atrial tachycardia. A total of 113 patients were enrolled at 3 centers; 29 in group 1 and 42 each in groups 2 and 3. Group 1 enrollment was terminated early for futility. Focal drivers or rotors were detected in all group 1 and 2 patients. Procedure time was significantly shorter in group 3 versus groups 1 and 2 (p < 0.001). In groups 1 and 2, acute success after rotor-only ablation was achieved in 12 patients (41%) and 11 (26%), respectively. After 12 ± 7 months' follow-up, 4 patients (14%), 22 (52.4%), and 32 (76%) in groups 1, 2, and 3, respectively, were AF/atrial tachycardia-free while off antiarrhythmic drugs (log-rank p 
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2016.04.015