Impact of rotor temperospatial stability on acute and one-year atrial fibrillation ablation outcomes

Muhammad Balouch, Esra Gucuk Ipek, Jonathan Chrispin, Rizma J. Bajwa, Tarek Zghaib, Ronald D Berger, Hiroshi Ashikaga, Saman Nazarian, Joseph Marine, Hugh Calkins, David D Spragg

Research output: Contribution to journalArticle

Abstract

Background: The utility of rotor ablation using commercially available systems as an adjunct to pulmonary vein isolation (PVI) is controversial. Variable results may stem from heterogeneous practice patterns. We investigated whether a prespecified protocol to determine temperospatial rotor stability improved acute and intermediate outcomes following rotor ablation. Hypothesis: Protocolized rotor mapping and ablation, with prespecified metrics to determine temporal rotor stability prior to ablation, will improve short- and long-term PVI/rotor ablation outcomes. Methods: Patients undergoing PVI plus rotor ablation at Johns Hopkins during 2015 were included. The first cohort underwent rotor mapping and ablation at the operator's discretion, whereas the second cohort underwent protocolized rotor mapping, with ablation limited to temperospatially stable rotors. Both cohorts underwent PVI. Acute results (rotor elimination, atrial fibrillation [AF] termination), procedural data, and 1-year outcomes were assessed. Results: Twenty-seven patients underwent ablation (mean age, 64.4 ± 9 years, male 81.5%, persistent AF 85.2%, long-standing persistent AF 14.8%, mean AF duration 4.4 ± 4 years, repeat cases 51.8%, and mean LA size 4.6 ± 0.8 cm). In the protocolized cohort, rotors were reproducible in 83% (10/12) of cases in at least 1 chamber. Acute rhythm change was achieved in 8/27 (29.6%) patients. Sinus rhythm on presentation (62.5% vs 15.8%, P = 0.03) and higher total targeted rotors (3.8 ± 1.7 vs 2.5 ± 1.0, P = 0.02) predicted acute change. At 12 months, freedom from AF/atrial tachycardia was achieved in 5/15 (33.3%) patients in the first cohort and 5/11 patients in the protocolized cohort (45.5%; P = 0.53 for comparison). Conclusions: Acute and intermediate results did not change with protocolized mapping designed to identify temperospatially stable rotors. Outcomes at 12 months were similar in both groups.

Original languageEnglish (US)
Pages (from-to)383-389
Number of pages7
JournalClinical Cardiology
Volume40
Issue number6
DOIs
StatePublished - Jun 1 2017

Fingerprint

Atrial Fibrillation
Pulmonary Veins
Tachycardia

Keywords

  • Arrhythmia
  • Atrial fibrillation
  • Catheter ablation
  • Focal impulse and rotor modulation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of rotor temperospatial stability on acute and one-year atrial fibrillation ablation outcomes. / Balouch, Muhammad; Gucuk Ipek, Esra; Chrispin, Jonathan; Bajwa, Rizma J.; Zghaib, Tarek; Berger, Ronald D; Ashikaga, Hiroshi; Nazarian, Saman; Marine, Joseph; Calkins, Hugh; Spragg, David D.

In: Clinical Cardiology, Vol. 40, No. 6, 01.06.2017, p. 383-389.

Research output: Contribution to journalArticle

@article{2369164d1a844536825b848154934567,
title = "Impact of rotor temperospatial stability on acute and one-year atrial fibrillation ablation outcomes",
abstract = "Background: The utility of rotor ablation using commercially available systems as an adjunct to pulmonary vein isolation (PVI) is controversial. Variable results may stem from heterogeneous practice patterns. We investigated whether a prespecified protocol to determine temperospatial rotor stability improved acute and intermediate outcomes following rotor ablation. Hypothesis: Protocolized rotor mapping and ablation, with prespecified metrics to determine temporal rotor stability prior to ablation, will improve short- and long-term PVI/rotor ablation outcomes. Methods: Patients undergoing PVI plus rotor ablation at Johns Hopkins during 2015 were included. The first cohort underwent rotor mapping and ablation at the operator's discretion, whereas the second cohort underwent protocolized rotor mapping, with ablation limited to temperospatially stable rotors. Both cohorts underwent PVI. Acute results (rotor elimination, atrial fibrillation [AF] termination), procedural data, and 1-year outcomes were assessed. Results: Twenty-seven patients underwent ablation (mean age, 64.4 ± 9 years, male 81.5{\%}, persistent AF 85.2{\%}, long-standing persistent AF 14.8{\%}, mean AF duration 4.4 ± 4 years, repeat cases 51.8{\%}, and mean LA size 4.6 ± 0.8 cm). In the protocolized cohort, rotors were reproducible in 83{\%} (10/12) of cases in at least 1 chamber. Acute rhythm change was achieved in 8/27 (29.6{\%}) patients. Sinus rhythm on presentation (62.5{\%} vs 15.8{\%}, P = 0.03) and higher total targeted rotors (3.8 ± 1.7 vs 2.5 ± 1.0, P = 0.02) predicted acute change. At 12 months, freedom from AF/atrial tachycardia was achieved in 5/15 (33.3{\%}) patients in the first cohort and 5/11 patients in the protocolized cohort (45.5{\%}; P = 0.53 for comparison). Conclusions: Acute and intermediate results did not change with protocolized mapping designed to identify temperospatially stable rotors. Outcomes at 12 months were similar in both groups.",
keywords = "Arrhythmia, Atrial fibrillation, Catheter ablation, Focal impulse and rotor modulation",
author = "Muhammad Balouch and {Gucuk Ipek}, Esra and Jonathan Chrispin and Bajwa, {Rizma J.} and Tarek Zghaib and Berger, {Ronald D} and Hiroshi Ashikaga and Saman Nazarian and Joseph Marine and Hugh Calkins and Spragg, {David D}",
year = "2017",
month = "6",
day = "1",
doi = "10.1002/clc.22674",
language = "English (US)",
volume = "40",
pages = "383--389",
journal = "Clinical Cardiology",
issn = "0160-9289",
publisher = "John Wiley and Sons Inc.",
number = "6",

}

TY - JOUR

T1 - Impact of rotor temperospatial stability on acute and one-year atrial fibrillation ablation outcomes

AU - Balouch, Muhammad

AU - Gucuk Ipek, Esra

AU - Chrispin, Jonathan

AU - Bajwa, Rizma J.

AU - Zghaib, Tarek

AU - Berger, Ronald D

AU - Ashikaga, Hiroshi

AU - Nazarian, Saman

AU - Marine, Joseph

AU - Calkins, Hugh

AU - Spragg, David D

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Background: The utility of rotor ablation using commercially available systems as an adjunct to pulmonary vein isolation (PVI) is controversial. Variable results may stem from heterogeneous practice patterns. We investigated whether a prespecified protocol to determine temperospatial rotor stability improved acute and intermediate outcomes following rotor ablation. Hypothesis: Protocolized rotor mapping and ablation, with prespecified metrics to determine temporal rotor stability prior to ablation, will improve short- and long-term PVI/rotor ablation outcomes. Methods: Patients undergoing PVI plus rotor ablation at Johns Hopkins during 2015 were included. The first cohort underwent rotor mapping and ablation at the operator's discretion, whereas the second cohort underwent protocolized rotor mapping, with ablation limited to temperospatially stable rotors. Both cohorts underwent PVI. Acute results (rotor elimination, atrial fibrillation [AF] termination), procedural data, and 1-year outcomes were assessed. Results: Twenty-seven patients underwent ablation (mean age, 64.4 ± 9 years, male 81.5%, persistent AF 85.2%, long-standing persistent AF 14.8%, mean AF duration 4.4 ± 4 years, repeat cases 51.8%, and mean LA size 4.6 ± 0.8 cm). In the protocolized cohort, rotors were reproducible in 83% (10/12) of cases in at least 1 chamber. Acute rhythm change was achieved in 8/27 (29.6%) patients. Sinus rhythm on presentation (62.5% vs 15.8%, P = 0.03) and higher total targeted rotors (3.8 ± 1.7 vs 2.5 ± 1.0, P = 0.02) predicted acute change. At 12 months, freedom from AF/atrial tachycardia was achieved in 5/15 (33.3%) patients in the first cohort and 5/11 patients in the protocolized cohort (45.5%; P = 0.53 for comparison). Conclusions: Acute and intermediate results did not change with protocolized mapping designed to identify temperospatially stable rotors. Outcomes at 12 months were similar in both groups.

AB - Background: The utility of rotor ablation using commercially available systems as an adjunct to pulmonary vein isolation (PVI) is controversial. Variable results may stem from heterogeneous practice patterns. We investigated whether a prespecified protocol to determine temperospatial rotor stability improved acute and intermediate outcomes following rotor ablation. Hypothesis: Protocolized rotor mapping and ablation, with prespecified metrics to determine temporal rotor stability prior to ablation, will improve short- and long-term PVI/rotor ablation outcomes. Methods: Patients undergoing PVI plus rotor ablation at Johns Hopkins during 2015 were included. The first cohort underwent rotor mapping and ablation at the operator's discretion, whereas the second cohort underwent protocolized rotor mapping, with ablation limited to temperospatially stable rotors. Both cohorts underwent PVI. Acute results (rotor elimination, atrial fibrillation [AF] termination), procedural data, and 1-year outcomes were assessed. Results: Twenty-seven patients underwent ablation (mean age, 64.4 ± 9 years, male 81.5%, persistent AF 85.2%, long-standing persistent AF 14.8%, mean AF duration 4.4 ± 4 years, repeat cases 51.8%, and mean LA size 4.6 ± 0.8 cm). In the protocolized cohort, rotors were reproducible in 83% (10/12) of cases in at least 1 chamber. Acute rhythm change was achieved in 8/27 (29.6%) patients. Sinus rhythm on presentation (62.5% vs 15.8%, P = 0.03) and higher total targeted rotors (3.8 ± 1.7 vs 2.5 ± 1.0, P = 0.02) predicted acute change. At 12 months, freedom from AF/atrial tachycardia was achieved in 5/15 (33.3%) patients in the first cohort and 5/11 patients in the protocolized cohort (45.5%; P = 0.53 for comparison). Conclusions: Acute and intermediate results did not change with protocolized mapping designed to identify temperospatially stable rotors. Outcomes at 12 months were similar in both groups.

KW - Arrhythmia

KW - Atrial fibrillation

KW - Catheter ablation

KW - Focal impulse and rotor modulation

UR - http://www.scopus.com/inward/record.url?scp=85021207159&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85021207159&partnerID=8YFLogxK

U2 - 10.1002/clc.22674

DO - 10.1002/clc.22674

M3 - Article

C2 - 28120392

AN - SCOPUS:85021207159

VL - 40

SP - 383

EP - 389

JO - Clinical Cardiology

JF - Clinical Cardiology

SN - 0160-9289

IS - 6

ER -