Poor outcome for rotor ablation in A-fib in randomized trial

(HealthDay)—For patients with non-paroxysmal atrial fibrillation (AF), rotor-only ablation is associated with a poor outcome compared with other ablation strategies, according to a randomized study published online May 6 in the Journal of the American College of Cardiology. The research was published to coincide with the annual meeting of the Heart Rhythm Society, held from May 4 to 7 in San Francisco.

Sanghamitra Mohanty, M.D., from St. David's Medical Center in Austin, Texas, and colleagues randomized non-paroxysmal AF patients undergoing first ablation to focal impulse and rotor modulation (FIRM)-guided ablation only (group 1; 29 patients), FIRM + pulmonary vein antrum isolation (PVAI) (group 2; 42 patients), or PVAI + posterior wall + non-PV trigger ablation (group 3; 42 patients).

The researchers terminated enrollment in group 1 early for futility. Procedure time was significantly shorter in group 3 versus groups 1 and 2 (P < 0.001). Acute success after rotor-only ablation was achieved in 41 and 26 percent of patients in groups 1 and 2, respectively. Overall, 14, 52.4, and 76.0 percent of patients in groups 1, 2, and 3 were AF/atrial tachycardia-free off anti-arrhythmic drugs after 12 ± 7-month follow-up (log-rank P < 0.0001). Compared with groups 1 and 2, group 3 patients experienced higher success.

"This is the first randomized study that compared three ablation strategies in non-paroxysmal AF patients and reported a very poor outcome with rotor-only ablation," the authors write.

Several authors disclosed financial ties to the pharmaceutical and medical device industries.

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