Stand-alone Focal Impulse and Rotor Modulation (FIRM) ablation versus second-generation cryoballoon pulmonary vein isolation for paroxysmal atrial fibrillation

Roland R. Tilz; Kivanc Yalin; Evgeny Lyan; Christian Hendrik Heeger; Michael Schlüter; Thomas Fink; Vanessa Sciacca; Spyridon Liosis; Karl Heinz Kuck; Sorin Ștefan Popescu; Kai Mortensen; Roza Meyer-Saraei; Charlotte Eitel; Julia Vogler

doi:10.1111/jce.15564

Stand-alone Focal Impulse and Rotor Modulation (FIRM) ablation versus second-generation cryoballoon pulmonary vein isolation for paroxysmal atrial fibrillation

Roland R. Tilz^*, Kivanc Yalin, Evgeny Lyan, Christian Hendrik Heeger, Michael Schlüter, Thomas Fink, Vanessa Sciacca, Spyridon Liosis, Karl Heinz Kuck, Sorin Ștefan Popescu, Kai Mortensen, Roza Meyer-Saraei, Charlotte Eitel, Julia Vogler

^*Corresponding author for this work

Clinic of Internal Medicine II - Cardiology

4 Citations (Scopus)

Abstract

Introduction: Focal Impulse and Rotor Modulation (FIRM) guided catheter ablation aiming at stable rotors has been investigated as a treatment option in patients with atrial fibrillation (AF). The objective of this study was to compare the safety and efficacy of FIRM-guided ablation with second-generation cryoballoon pulmonary vein isolation (CB2-PVI) in paroxysmal AF. Methods: Consecutive patients (n = 22, mean age 60 ± 11 years, 59.1% of males) who were treated with a stand-alone FIRM-guided ablation were included in this retrospective single-center study. Procedural data and arrhythmia-free survival at 12 months were compared with n = 86 consecutive patients (mean age 62 ± 13 years, 62.4% of males) who received de-novo CB2-PVI. Results: Median procedure duration was significantly longer in the FIRM group than in the CB2-PVI group (152 [IQR 120–176] minutes vs. 122 [110–145] minutes; p =.031). One patient (1.2%) in the CB2-PVI group and five patients (22.7%) in the FIRM group had vascular access complications. Atrial tachyarrhythmias recurred in 15 patients in the FIRM group and 11 in the CB2-PVI group. Kaplan–Meier estimation of single-procedure arrhythmia-free survival at 12 months was 25% (95% confidence interval [CI] 6%–44%) in the FIRM group and 87% (95% CI 78%–96%) in the CB2-PVI group (p <.001). Repeat ablations were performed in 14/20 (70.0%) patients in the FIRM group and in 12/85 (14.1%) in the CB2-PVI group (p <.001). Conclusion: De novo ablation of AF using FIRM-guided AF ablation results in shorter arrhythmia-free survival after 12 months compared to CB2-PVI and a need for repeat ablation in the majority of patients to achieve stable sinus rhythm.

Original language	English
Journal	Journal of Cardiovascular Electrophysiology
Volume	33
Issue number	8
Pages (from-to)	1678-1686
Number of pages	9
ISSN	1045-3873
DOIs	https://doi.org/10.1111/jce.15564
Publication status	Published - 08.2022

Funding

: RRT received research grants from Medtronic, Biotronik, travel grants from Biosense Webster, Medtronic, Abbot, SentreHeart, and Daiichi Sankyo, speakers bureau/proctor honoraria from Biosense Webster, Medtronic, Abbot, Sentrheart and Daiichi Sankyo; he is consultant of Biosense Webster and Biotronik. KY received a research grant from the Turkish Society of Cardiology. EL received travel grants, research grants, and speaker's honoraria from Biosense Webster, Abbott, Boston Scientific, and Medtronic. AA received travel grants from Medtronic and Biotronik, speaker's honoraria from Novartis. CHH received travel grants, research grants, and speaker's honoraria by Medtronic, Claret Medical, SentreHeart, Boston Scientific, Pfizer, Biosense Webster, Johnson & Johnson, and Cardiofocus. TF received travel grants by Novartis, SentreHeart and Biosense Webster. KHK received travel grants and research grants from Biosense Webster, Stereotaxis, Prorhythm, Medtronic, Edwards, Cryocath, and is a consultant to St. Jude Medical, Biosense Webster, Prorhythm, and Stereotaxis. He received speaker's honoraria from Medtronic. RMS received travel grants from Bayer. CE received travel grants from Biosense Webster, Medtronic, Biotronik, Abbott, and Daiichi Sankyo, speaker's honoraria from Biosense Webster, Medtronic, Abbott, Sentrheart, and Daiichi Sankyo. JV received travel grants from Bayer, Biosense Webster, and Daiichi Sankyo, speaker's honoraria from Abbott, Daiichi Sankyo, and Novartis. All other authors report no conflicts of interest. Disclosures

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Research Areas and Centers

Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

2.22-12 Cardiology, Angiology

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10.1111/jce.15564

Cite this

Tilz, R. R., Yalin, K., Lyan, E., Heeger, C. H., Schlüter, M., Fink, T., Sciacca, V., Liosis, S., Kuck, K. H., Popescu, S. Ș., Mortensen, K., Meyer-Saraei, R., Eitel, C., & Vogler, J. (2022). Stand-alone Focal Impulse and Rotor Modulation (FIRM) ablation versus second-generation cryoballoon pulmonary vein isolation for paroxysmal atrial fibrillation. Journal of Cardiovascular Electrophysiology, 33(8), 1678-1686. https://doi.org/10.1111/jce.15564

@article{689195b6dc004f8495020b96610c1035,

title = "Stand-alone Focal Impulse and Rotor Modulation (FIRM) ablation versus second-generation cryoballoon pulmonary vein isolation for paroxysmal atrial fibrillation",

abstract = "Introduction: Focal Impulse and Rotor Modulation (FIRM) guided catheter ablation aiming at stable rotors has been investigated as a treatment option in patients with atrial fibrillation (AF). The objective of this study was to compare the safety and efficacy of FIRM-guided ablation with second-generation cryoballoon pulmonary vein isolation (CB2-PVI) in paroxysmal AF. Methods: Consecutive patients (n = 22, mean age 60 ± 11 years, 59.1\% of males) who were treated with a stand-alone FIRM-guided ablation were included in this retrospective single-center study. Procedural data and arrhythmia-free survival at 12 months were compared with n = 86 consecutive patients (mean age 62 ± 13 years, 62.4\% of males) who received de-novo CB2-PVI. Results: Median procedure duration was significantly longer in the FIRM group than in the CB2-PVI group (152 [IQR 120–176] minutes vs. 122 [110–145] minutes; p =.031). One patient (1.2\%) in the CB2-PVI group and five patients (22.7\%) in the FIRM group had vascular access complications. Atrial tachyarrhythmias recurred in 15 patients in the FIRM group and 11 in the CB2-PVI group. Kaplan–Meier estimation of single-procedure arrhythmia-free survival at 12 months was 25\% (95\% confidence interval [CI] 6\%–44\%) in the FIRM group and 87\% (95\% CI 78\%–96\%) in the CB2-PVI group (p <.001). Repeat ablations were performed in 14/20 (70.0\%) patients in the FIRM group and in 12/85 (14.1\%) in the CB2-PVI group (p <.001). Conclusion: De novo ablation of AF using FIRM-guided AF ablation results in shorter arrhythmia-free survival after 12 months compared to CB2-PVI and a need for repeat ablation in the majority of patients to achieve stable sinus rhythm.",

author = "Tilz, \{Roland R.\} and Kivanc Yalin and Evgeny Lyan and Heeger, \{Christian Hendrik\} and Michael Schl{\"u}ter and Thomas Fink and Vanessa Sciacca and Spyridon Liosis and Kuck, \{Karl Heinz\} and Popescu, \{Sorin Ștefan\} and Kai Mortensen and Roza Meyer-Saraei and Charlotte Eitel and Julia Vogler",

note = "Publisher Copyright: {\textcopyright} 2022 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.",

year = "2022",

month = aug,

doi = "10.1111/jce.15564",

language = "English",

volume = "33",

pages = "1678--1686",

journal = "Journal of Cardiovascular Electrophysiology",

issn = "1045-3873",

publisher = "John Wiley and Sons Inc",

number = "8",

}

Tilz, RR, Yalin, K, Lyan, E, Heeger, CH, Schlüter, M, Fink, T, Sciacca, V, Liosis, S, Kuck, KH, Popescu, SȘ, Mortensen, K, Meyer-Saraei, R , Eitel, C & Vogler, J 2022, 'Stand-alone Focal Impulse and Rotor Modulation (FIRM) ablation versus second-generation cryoballoon pulmonary vein isolation for paroxysmal atrial fibrillation', Journal of Cardiovascular Electrophysiology, vol. 33, no. 8, pp. 1678-1686. https://doi.org/10.1111/jce.15564

Stand-alone Focal Impulse and Rotor Modulation (FIRM) ablation versus second-generation cryoballoon pulmonary vein isolation for paroxysmal atrial fibrillation. / Tilz, Roland R.; Yalin, Kivanc; Lyan, Evgeny et al.
In: Journal of Cardiovascular Electrophysiology, Vol. 33, No. 8, 08.2022, p. 1678-1686.

Research output: Journal Articles › Journal articles › Research › peer-review

TY - JOUR

T1 - Stand-alone Focal Impulse and Rotor Modulation (FIRM) ablation versus second-generation cryoballoon pulmonary vein isolation for paroxysmal atrial fibrillation

AU - Tilz, Roland R.

AU - Yalin, Kivanc

AU - Lyan, Evgeny

AU - Heeger, Christian Hendrik

AU - Schlüter, Michael

AU - Fink, Thomas

AU - Sciacca, Vanessa

AU - Liosis, Spyridon

AU - Kuck, Karl Heinz

AU - Popescu, Sorin Ștefan

AU - Mortensen, Kai

AU - Meyer-Saraei, Roza

AU - Eitel, Charlotte

AU - Vogler, Julia

PY - 2022/8

Y1 - 2022/8

N2 - Introduction: Focal Impulse and Rotor Modulation (FIRM) guided catheter ablation aiming at stable rotors has been investigated as a treatment option in patients with atrial fibrillation (AF). The objective of this study was to compare the safety and efficacy of FIRM-guided ablation with second-generation cryoballoon pulmonary vein isolation (CB2-PVI) in paroxysmal AF. Methods: Consecutive patients (n = 22, mean age 60 ± 11 years, 59.1% of males) who were treated with a stand-alone FIRM-guided ablation were included in this retrospective single-center study. Procedural data and arrhythmia-free survival at 12 months were compared with n = 86 consecutive patients (mean age 62 ± 13 years, 62.4% of males) who received de-novo CB2-PVI. Results: Median procedure duration was significantly longer in the FIRM group than in the CB2-PVI group (152 [IQR 120–176] minutes vs. 122 [110–145] minutes; p =.031). One patient (1.2%) in the CB2-PVI group and five patients (22.7%) in the FIRM group had vascular access complications. Atrial tachyarrhythmias recurred in 15 patients in the FIRM group and 11 in the CB2-PVI group. Kaplan–Meier estimation of single-procedure arrhythmia-free survival at 12 months was 25% (95% confidence interval [CI] 6%–44%) in the FIRM group and 87% (95% CI 78%–96%) in the CB2-PVI group (p <.001). Repeat ablations were performed in 14/20 (70.0%) patients in the FIRM group and in 12/85 (14.1%) in the CB2-PVI group (p <.001). Conclusion: De novo ablation of AF using FIRM-guided AF ablation results in shorter arrhythmia-free survival after 12 months compared to CB2-PVI and a need for repeat ablation in the majority of patients to achieve stable sinus rhythm.

AB - Introduction: Focal Impulse and Rotor Modulation (FIRM) guided catheter ablation aiming at stable rotors has been investigated as a treatment option in patients with atrial fibrillation (AF). The objective of this study was to compare the safety and efficacy of FIRM-guided ablation with second-generation cryoballoon pulmonary vein isolation (CB2-PVI) in paroxysmal AF. Methods: Consecutive patients (n = 22, mean age 60 ± 11 years, 59.1% of males) who were treated with a stand-alone FIRM-guided ablation were included in this retrospective single-center study. Procedural data and arrhythmia-free survival at 12 months were compared with n = 86 consecutive patients (mean age 62 ± 13 years, 62.4% of males) who received de-novo CB2-PVI. Results: Median procedure duration was significantly longer in the FIRM group than in the CB2-PVI group (152 [IQR 120–176] minutes vs. 122 [110–145] minutes; p =.031). One patient (1.2%) in the CB2-PVI group and five patients (22.7%) in the FIRM group had vascular access complications. Atrial tachyarrhythmias recurred in 15 patients in the FIRM group and 11 in the CB2-PVI group. Kaplan–Meier estimation of single-procedure arrhythmia-free survival at 12 months was 25% (95% confidence interval [CI] 6%–44%) in the FIRM group and 87% (95% CI 78%–96%) in the CB2-PVI group (p <.001). Repeat ablations were performed in 14/20 (70.0%) patients in the FIRM group and in 12/85 (14.1%) in the CB2-PVI group (p <.001). Conclusion: De novo ablation of AF using FIRM-guided AF ablation results in shorter arrhythmia-free survival after 12 months compared to CB2-PVI and a need for repeat ablation in the majority of patients to achieve stable sinus rhythm.

UR - https://www.scopus.com/pages/publications/85132572361

U2 - 10.1111/jce.15564

DO - 10.1111/jce.15564

M3 - Journal articles

C2 - 35615939

AN - SCOPUS:85132572361

SN - 1045-3873

VL - 33

SP - 1678

EP - 1686

JO - Journal of Cardiovascular Electrophysiology

JF - Journal of Cardiovascular Electrophysiology

IS - 8

ER -

Stand-alone Focal Impulse and Rotor Modulation (FIRM) ablation versus second-generation cryoballoon pulmonary vein isolation for paroxysmal atrial fibrillation

Abstract

Funding

UN SDGs

Research Areas and Centers

DFG Research Classification Scheme

Access to Document

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