Krummen David E, Baykaner Tina, Schricker Amir A, Kowalewski Christopher A B, Swarup Vijay, Miller John M, Tomassoni Gery F, Park Shirley, Viswanathan Mohan N, Wang Paul J, Narayan Sanjiv M
Department of Medicine, University of California San Diego and VA San Diego Healthcare System, 3350 La Jolla Village Drive, Cardiology Section 111A, San Diego, CA 92161, USA.
Department of Medicine, Stanford University, 780 Welch Road MC-5773, Stanford, Palo Alto, CA 94305, USA.
Europace. 2017 May 1;19(5):769-774. doi: 10.1093/europace/euw377.
Focal Impulse and Rotor Modulation (FIRM) uses 64-electrode basket catheters to identify atrial fibrillation (AF)-sustaining sites for ablation, with promising results in many studies. Accordingly, new basket designs are being tested by several groups. We set out to determine the procedural safety of adding basket mapping and map-guided ablation to conventional pulmonary vein isolation (PVI).
We collected 30 day procedural safety data in five US centres for consecutive patients undergoing FIRM plus PVI (FIRM-PVI) compared with contemporaneous controls undergoing PVI without FIRM. A total of 625 cases were included in this analysis: 325 FIRM-PVI and 300 PVI-controls. FIRM-PVI patients were more likely than PVI-controls to be male (83% vs. 66%, P < 0.001) and have long-standing persistent AF (26% vs. 13%, P < 0.001) reflecting patients referred for FIRM. Total ablation time was greater for FIRM-PVI (62 ± 22 min) vs. PVI-controls (52 ± 18 min, P = 0.03). The complication rate for FIRM-PVI procedures (4.3%) was similar to controls (4.0%, P = 1) for both major and minor complications; no deaths were reported. The rate of complications potentially attributable to the basket catheter was small and did not differ between basket types (Constellation 2.8% vs. FIRMap 1.8%, P = 0.7) or between cases in which basket catheters were and were not used (P = 0.5). Complication rates did not differ between centres (P = 0.6).
Procedural complications from the use of the basket catheters for AF mapping are low, and thus procedural safety appears similar between FIRM-PVI and PVI-controls in a large multicentre cohort. Future studies are required to determine the optimal approach to maximize the efficacy of FIRM-guided ablation.
局灶冲动与转子调制（FIRM）使用64极篮状导管来识别房颤（AF）维持部位以进行消融，在许多研究中取得了有前景的结果。因此，几个研究团队正在测试新型篮状导管设计。我们旨在确定在传统肺静脉隔离（PVI）基础上增加篮状标测和标测引导消融的手术安全性。
我们收集了美国五个中心连续接受FIRM联合PVI（FIRM-PVI）治疗患者的30天手术安全性数据，并与同期接受无FIRM的PVI治疗的对照组进行比较。本分析共纳入625例病例：325例FIRM-PVI和300例PVI对照组。FIRM-PVI组患者比PVI对照组更可能为男性（83%对66%，P<0.001）且患有长期持续性房颤（26%对13%，P<0.001），这反映了被转诊接受FIRM治疗的患者情况。FIRM-PVI组的总消融时间（62±22分钟）长于PVI对照组（52±18分钟，P=0.03）。FIRM-PVI手术的并发症发生率（4.3%）与对照组（4.0%，P=1）在主要和次要并发症方面相似；未报告死亡病例。可能归因于篮状导管的并发症发生率较低，且在不同类型篮状导管之间（星座型2.8%对FIRMap型1.8%，P=0.7）或使用和未使用篮状导管的病例之间（P=0.5）无差异。各中心之间的并发症发生率无差异（P=0.6）。
使用篮状导管进行房颤标测的手术并发症较低，因此在大型多中心队列中，FIRM-PVI和PVI对照组的手术安全性似乎相似。未来需要进行研究以确定使FIRM引导消融疗效最大化的最佳方法。
