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Dual-atria rotor modification: A comparative analysis of rotor modification and posterior wall isolation in patients
Yoshifumi Okano1, Hironobu Tanii1, Katsuya Akitsu1
1Division of Cardiology, Tokyo Metropolitan Ohkubo Hospital, Shinjyuku-ku, Tokyo, Japan.
Background:
Various methods have been devised for catheter ablation of persistent atrial fibrillation (AF). However, it remains difficult to understand the mechanism of AF and to determine the optimal method.
Objective:
This study aimed to evaluate the effectiveness of rotor modification (RM) compared to posterior wall isolation (PWI) in the treatment of persistent AF.
Methods:
The study included 50 patients in the RM group (mean age: 67.0 ± 8.7 years; 76% with long-standing persistent AF) and 50 patients in the PWI group (mean age: 66.8 ± 8.9 years; 66%). In the RM group, in addition to cryoballoon isolation of the pulmonary veins, rotors in both atria were identified using a phase mapping system and ablated at low power. In the PWI group, the pulmonary vein antrum and posterior wall were isolated together using a radiofrequency catheter. The primary end point was the maintenance of sinus rhythm, defined as freedom from atrial tachycardia, AF, and atrial flutter over a 36-month postoperative follow-up period.
Results:
Survival curve analysis using the log-rank test revealed a statistically significant difference (P < .001), demonstrating the superiority of RM.
Conclusion:
RM is suggested to be as effective as PWI or more effective in maintaining sinus rhythm in patients with persistent AF.
