Rotational activity ablation added to PVI shows 91.5% sinus rhythm in persistent AF cohort
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Key Takeaway
Consider rotational activity ablation plus PVI for persistent AF, but note evidence is from an observational cohort.
This prospective multicenter cohort study evaluated 76 patients with persistent atrial fibrillation (AF) who received ablation of rotational activity (RotAct) on top of pulmonary vein isolation (PVI), compared to 56 control patients receiving a standard ablation protocol. The primary outcome was maintenance of sinus rhythm during a mean follow-up of 13 ± 6 months. RotAct was identified in 29 patients (38%) at initial mapping. PVI significantly modified the number and localization of RotActs, with disappearance in 18 patients and new appearance in 5 patients (p=0.012).
At follow-up, 91.5% of patients in the RotAct ablation group were in stable sinus rhythm, compared to 78.6% in the control group (p=0.025). The study reports this as a significant reduction in relapse for the tailored ablation strategy. Safety and tolerability data, including adverse events and discontinuations, were not reported.
Key limitations include the observational cohort design, which cannot establish causality, and the lack of reported safety data. The sample size was modest, and follow-up duration was intermediate. Funding sources and author conflicts of interest were not reported. The practice relevance is that a tailored ablation strategy targeting RotAct in addition to PVI was associated with a high procedural success rate in this specific cohort, but these findings are preliminary and require validation in randomized controlled trials before clinical adoption can be considered.
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View Original Abstract ↓
Background-aimsRecently, the etiopathogenetic role of rotational activity (RotAct) in atrial fibrillation (AF) has been proposed. We designed a prospective multicenter study using CARTO Finder to evaluate the presence/distribution of RotActs in persistent AF (persAF), pulmonary vein isolation (PVI)influences on RotActs, and the impact of its elimination on top of PVI on procedural outcomes.MethodsFor this study, 76 patients with pers AF ablation were enrolled. Procedural steps involved (1) using a CARTO-Finder map to look for RotActs (physician blinded); (2) PVI; (3) using a new map to look for residual/new RotActs; (4) ablation of RotActs, if present; (5) and finally using a new map to confirm RotAct elimination. Populations were divided based on the presence or absence of structural heart disease (Group I and II) and the presence or absence (R+ and R−) of RotActs before PVI. Presence, number, and distribution of RotAct at STEP 1, the impact of PVI on RotAct at STEP 3, and maintenance of sinus rhythm (SR) during follow-up were evaluated. 56 AF patients undergoing standard ablation protocol were included as a control group.ResultsRotAct was identified in 29 (38%) patients at STEP1. RotAct did not differ between GI and GII patients. PVI significantly modified the number and localization of RotActs (p = 0.012). RotActs which were present at STEP 1 were different after PVI, with disappearance in 18 and new appearance in 5 patients. 71 patients completed a mean 13 ± 6 months follow-up and 91.5% were in stable SR. No difference in relapses was seen between R + and R- and GI and GII. RotAct ablation significantly reduced arrhythmia relapse during the follow-up compared to the control group (freedom from arrhythmia 91.5% vs. 78.6%, p = 0.025).ConclusionRotAct was present in 38% in persAF patients. PVI influenced the number and distribution of RotActs. A tailored ablation strategy provided a high success rate (91.5%) at the follow-up.
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