Rotor-only ablation ineffective option for nonparoxysmal AF

SAN FRANCISCO — Patients with nonparoxysmal atrial fibrillation who underwent rotor-only ablation did not reach freedom from atrial tachycardia/AF, researchers reported at the Heart Rhythm Society Annual Scientific Sessions.

“There hadn’t been a randomized controlled trial before, so it was important to conduct this study to reach an unbiased look at this technology,” Andrea Natale, MD, FHRS, executive medical director, Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin, said during a press conference.

Andrea Natale

Natale and colleagues randomly assigned 113 patients to one of three groups — focal impulse and rotor modulation ablation (group 1; Topera, Abbott), focal impulse and rotor modulation ablation with pulmonary vein antrum isolation (group 2) or pulmonary vein antrum isolation plus posterior wall and nonpulmonary vein trigger ablation (group 3). The primary endpoint was freedom from atrial tachyarrhythmia/AF off antiarrhythmic drugs. Acute procedural success (AF termination or 10% slowing or organization into atrial tachycardia) was a secondary endpoint.

According to the results, procedure time was approximately 222 minutes in group 1, 233 minutes in group 2 and 131 minutes in group 3 (P < .05 for group 3 vs. other groups).

In the first two groups, acute success was observed in 41% and 26% of patients, respectively, after rotor-only ablation. In addition, after 12 months of follow-up, freedom from atrial tachyarrhythmia/AF off antiarrhythmic drugs was achieved in 14% of patients in group 1, 52.4% in group 2 and 76% of patients in group 3 (log-rank P < .0001). Patients in group 3 had a higher success rate than patients in group 2 (log-rank P = .02).

In patients with persistent AF, the success rate was 53% in group 2 and 72% in group 3, and in patients with long-standing persistent AF, success rates were 50% and 84.6%, respectively.

According to the researchers, not only did the rotor-only ablation group have poorer outcomes, the pulmonary vein antrum isolation plus rotor ablation group had longer procedure times and lower success rates than patients who underwent pulmonary vein antrum isolation plus posterior wall and nonpulmonary vein trigger ablation.

“I don’t think this is the end of the technology, but it certainly brought up some questions,” Natale said. “The community is split between believers and nonbelievers when it comes to rotor mapping technology. I am not a believer after this study.”

Natale said he would like to see more large and comparative studies conducted on this technology and others. – by Tracey Romero

Reference:

Natale A, et al. LBCT 02. Presented at: Heart Rhythm Society Annual Scientific Sessions; May 4-7, 2016; San Francisco.

Disclosure: Natale reports funding from Biosense Webster, Boston Scientific, Janssen Pharmaceuticals, Medtronic and St. Jude Medical.