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Gautam G Lalani, Thomas Coysh, Tina Baykaner, Junaid Zaman, Kenneth Hopper, Amir A Schricker, Rishi Trikha, Paul Clopton, David E Krummen, Sanjiv M Narayan
INTRODUCTION: Recurrent atrial fibrillation (AF) after ablation is associated with reconnection of initially isolated pulmonary vein (PV) trigger sites. Substrates are often targeted in addition to PVI, but it is unclear how substrates progress over time. We studied if substrates in recurrent AF are conserved or have developed de novo from pre-ablation AF. METHODS AND RESULTS: Of 137 patients undergoing Focal Impulse and Rotor Mapping (FIRM) at their index procedure for AF, 29 consecutive patients (60 ± 8 years, 79% persistent) recurred and were also mapped at repeat procedure (21 ± 20 months later) using carefully placed 64-pole baskets and RhythmView(TM) (Topera, Menlo Park, CA, USA) to identify AF sources and disorganized zones...
June 2016: Journal of Cardiovascular Electrophysiology
Vijay Swarup, Tina Baykaner, Armand Rostamian, James P Daubert, John Hummel, David E Krummen, Rishi Trikha, John M Miller, Gery F Tomassoni, Sanjiv M Narayan
INTRODUCTION: Several groups report electrical rotors or focal sources that sustain atrial fibrillation (AF) after it has been triggered. However, it is difficult to separate stable from unstable activity in prior studies that examined only seconds of AF. We applied phase-based focal impulse and rotor mapping (FIRM) to study the dynamics of rotors/sources in human AF over prolonged periods of time. METHODS: We prospectively mapped AF in 260 patients (169 persistent, 61 ± 12 years) at 6 centers in the FIRM registry, using baskets with 64 contact electrodes per atrium...
December 2014: Journal of Cardiovascular Electrophysiology
John M Miller, Robert C Kowal, Vijay Swarup, James P Daubert, Emile G Daoud, John D Day, Kenneth A Ellenbogen, John D Hummel, Tina Baykaner, David E Krummen, Sanjiv M Narayan, Vivek Y Reddy, Kalyanam Shivkumar, Jonathan S Steinberg, Kevin R Wheelan
INTRODUCTION: The success of pulmonary vein isolation (PVI) for atrial fibrillation (AF) may be improved if stable AF sources identified by Focal Impulse and Rotor Mapping (FIRM) are also eliminated. The long-term results of this approach are unclear outside the centers where FIRM was developed; thus, we assessed outcomes of FIRM-guided AF ablation in the first cases at 10 experienced centers. METHODS: We prospectively enrolled n = 78 consecutive patients (61 ± 10 years) undergoing FIRM guided ablation for persistent (n = 48), longstanding persistent (n = 7), or paroxysmal (n = 23) AF...
September 2014: Journal of Cardiovascular Electrophysiology
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