Abstract
Purpose: Rotor activity can be demonstrated in patients (Pts) with atrial fibrillation(AF) by using a special mapping procedure (FIRM-mapping). The objective of the registry is to assess the safety and effectiveness of FIRM guided procedures for the treatment of symptomatic paroxysmal, persistent and long lasting atrial fibrillation. Methods: 138 Pts (91/66% male, mean age 62,5 yrs.) with an average weight 92kg +/-16 (59 to 141kg) paroxysmal (28/18%), persistent (109/80%) and long-persistent AF (6/4%) underwent the FIRM-mapping and ablation procedure. Procedural data, initial results and follow-up (FU) at 3, 6 and 12 months were documented. Results: Mean left atrial (LA) size was 55 +/-8 mm (septal to ridge) and 54 +/-10 mm (ridge to mitral annulus); measured by ICE (50/47%), by CT/MRI (36/33%) and by 3D-Mapping (22/21%), respectively. The basket size had been for 6% of the pts 70mm, 50% with 60mm and 44% with 50mm. The no. of rotors was 2,8 ± 1,6 in the right atrium (RA) and 5,5 ± 3,0 in LA. 70% of all patients required an electrical cardioversion at the end of the procedure. All rotors were ablated by using a standard radiofrequency (RF) ablation catheter. In 85 Pts (70%) an additional pulmonary vein isolation (PVI) was performed, with successful isolation in 100% of the right pulmonary veins (PVs) and 97% of the left PVs; in 13 Pts (15%) an additional ablation line was created. The mean procedural time was 4 h:56 min, the mean fluoroscopy time 28,4 +/- 17 (3 to 88) min. Post procedural, 122 Pts (93%) were in sinus rhythm (SR). Complications occurred as follows: 6 Pts with groin bleeding, 1 Pts with infection, 2 Pts with TIA, 2 Pts with pacemaker, 2 pericardial effusion, 1 atriovenous fistula. FU-data were available in 89 Pts at 3 months, in 55 Pts at 6 months and in 31 Pts at 12 months, with SR-rates of 78%, 78% and 72%, respectively. Conclusion: The E-FIRM registry of atrial fibrillation ablation by using the FIRM-mapping approach preliminarly demonstrates a mean of 2,8 RA rotors and 3,7 LA rotors in a mixed AF-patient-cohort. The 6- and 12-months SR-rates (78%, 72%) are encouraging.
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