Abstract:
BACKGROUND:Focal impulse and rotor modulation (FIRM) was based on the premise that atrial fibrillation (AF) is sustained by rotors that are sufficiently stable to be eliminated by targeted ablation. Early experience reported high success as compared to conventional strategies. OBJECTIVE:The purpose of this study was to report on a single-center experience with extended follow-up by using FIRM in a variety of patients with AF. METHODS:All FIRM-guided ablation procedures were included. During spontaneous or induced AF, FIRM software constructed phase maps to identify putative AF sources, then targeted for radiofrequency ablation, with adjunctive pulmonary vein isolation (PVI), if needed. All mapped rotors and/or sources were eliminated on the basis of repeated FIRM mapping. RESULTS:Of 47 patients, sustained AF was not present or induced in 4 patients who did not undergo FIRM ablation. Of the remaining 43 patients, prior AF was paroxysmal in 9 (21%) and 72% had a median of 1 prior PVI. Spontaneous AF (n = 22, 52%) and induced AF (n = 21, 49%) were mapped, and all patients had rotors identified (1.8 ± 0.8 per patient; 70% in the left atrium). AF termination occurred in 2 patients (5%) and none organized to atrial tachycardia. Touch-up redo PVI was also performed in 31 patients (72%). At 16.0 ± 10.7 months (range 1-34 months), only 9 patients (21%) were free of recurrent AF; and only 5 patients (12%) were free of AF and off antiarrhythmic drugs. CONCLUSION:Long-term clinical results after FIRM ablation in this diverse challenging cohort showed poor efficacy. Randomized clinical trials are needed to evaluate the efficacy and clinical utility of the FIRM ablation approach for treating AF.
journal_name
Heart Rhythmjournal_title
Heart rhythmauthors
Steinberg JS,Shah Y,Bhatt A,Sichrovsky T,Arshad A,Hansinger E,Musat Ddoi
10.1016/j.hrthm.2016.11.008subject
Has Abstractpub_date
2017-02-01 00:00:00pages
192-197issue
2eissn
1547-5271issn
1556-3871pii
S1547-5271(16)31009-8journal_volume
14pub_type
杂志文章相关文献
HEART RHYTHM文献大全abstract:BACKGROUND:Complete atrioventricular block (CAVB) causes arrhythmogenic remodeling and increases the risk of torsades de pointes arrhythmias. MicroRNAs (miRNAs) are key regulators of gene expression that contribute to cardiac remodeling. OBJECTIVE:The purpose of this study was to assess miRNA changes after CAVB and id...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2017.01.045
更新日期:2017-05-01 00:00:00
abstract:BACKGROUND:Atrial fibrillation (AF) ablation is increasingly used in patients with reduced left ventricular ejection fraction (LVEF), but long-term outcomes are still unknown. OBJECTIVE:To assess the long-term effects of AF ablation in patients with systolic heart failure according to rhythm outcome. METHODS:We inclu...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2013.12.031
更新日期:2014-03-01 00:00:00
abstract:BACKGROUND:Several mammalian species display distinct biophysical properties between atrial and ventricular voltage-gated sodium current (INa); however, the potential mechanism behind this phenomenon is unknown. OBJECTIVE:The purpose of this study was to investigate the potential molecular identities of the different ...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2015.11.022
更新日期:2016-03-01 00:00:00
abstract:BACKGROUND:Pericardial effusion, a sign of cardiac perforation, may complicate permanent pacemaker placement. Risk factors for development of post-permanent pacemaker effusion have not been evaluated. OBJECTIVES:The purpose of this study was to determine the predictors of symptomatic pericardial effusion after permane...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2005.06.011
更新日期:2005-09-01 00:00:00
abstract:BACKGROUND:Obstructive sleep apnea (OSA) causes negative tracheal pressure (NTP) and is associated with atrial fibrillation (AF). OBJECTIVE:This study aimed to determine the mechanism of atrial electrophysiological changes during tracheal occlusion with or without applied NTP and to evaluate the role of vagal activati...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2011.03.053
更新日期:2011-09-01 00:00:00
abstract:BACKGROUND:Atrial fibrillation (AF) often progresses to more sustained forms and increases the risk of ischemic stroke or sinus node dysfunction. However, there have been no data on the clinical outcomes of patients who developed AF during head-up tilt testing (HUT). OBJECTIVE:The purpose of this study was to evaluate...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2018.11.030
更新日期:2019-04-01 00:00:00
abstract:BACKGROUND:The availability of safe and effective drugs for the management of atrial fibrillation (AF) remains an unmet medical need. OBJECTIVES:The purpose of this study was to test the hypothesis that the inhibition of the rapidly activating delayed rectifier potassium current (IKr) greatly potentiates the developme...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2014.12.033
更新日期:2015-04-01 00:00:00
abstract:BACKGROUND:Epicardial pacing increases risk of ventricular tachycardia (VT) in patients with ischemic cardiomyopathy (ICM) when pacing in proximity to scar. Endocardial pacing may be less arrhythmogenic as it preserves the physiological sequences of activation and repolarization. OBJECTIVE:The purpose of this study wa...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2020.03.021
更新日期:2020-08-01 00:00:00
abstract:BACKGROUND:Pectoral nerve blocks (PECs) can reduce intraprocedural anesthetic requirements and postoperative pain. Little is known about the utility of PECs in reducing pain and narcotic use after pacemaker (PM) or implantable cardioverter-defibrillator (ICD) placement in children. OBJECTIVE:The purpose of this study ...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2020.03.009
更新日期:2020-08-01 00:00:00
abstract:BACKGROUND/OBJECTIVE:The purpose of this study was to characterize the association between the extent of left atrial electroanatomic remodeling in atrial fibrillation and the atrial fibrillation cycle length derived from lead V₁ of the surface ECG (V1AFCL). METHODS:Twenty-three patients in atrial fibrillation (AF) who...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2013.12.034
更新日期:2014-04-01 00:00:00
abstract:BACKGROUND:Atrial tachyarrhythmias (AT) are considered progressive diseases. Several rhythm control therapies for treatment of AT have been proposed. OBJECTIVES:The Italian AT500 Registry was designed to prospectively study long-term AT evolution in patients paced for the brady-tachy form of sinus node disease (BT-SND...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2005.07.011
更新日期:2005-10-01 00:00:00
abstract:BACKGROUND:Loss-of-function mutations in SCN5A are associated in ∼20% of Brugada syndrome (BrS) patients. Copy number variations (CNVs) have been shown to be associated with several inherited arrhythmia syndromes. OBJECTIVE:The purpose of this study was to investigate SCN5A CNVs among BrS probands. METHODS:The study ...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2018.03.033
更新日期:2018-08-01 00:00:00
abstract:BACKGROUND:In normal atrial and ventricular tissue, the electrical wavefronts are mediated by the fast sodium current (I(Na)), whereas in sinoatrial and atrioventricular nodal tissue, conduction is mediated by the slow L-type calcium current (I(Ca,L)). However, it has not been shown whether the same tissue can exhibit ...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2011.08.014
更新日期:2012-01-01 00:00:00
abstract::Pregnancy is a period of increased cardiovascular risk in a woman's life. In the setting of an inherited arrhythmia syndrome (IAS), cardiologists and obstetricians may be unfamiliar with cardiovascular optimization and risk stratification in pregnancy. Historically, there were little data addressing the safety of preg...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2019.08.004
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:Diabetes and obesity are associated with an increased risk of arrhythmia and sudden cardiac death. Abnormal lipid accumulation is observed in cardiomyocytes of obese and diabetic patients, which may contribute to arrhythmia, but the mechanisms are poorly understood. A transgenic mouse model of cardiac lipid ...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2016.05.002
更新日期:2016-08-01 00:00:00
abstract::Atrial fibrillation is a marker for worse outcomes in patients with heart failure and requires careful, individualized management. Anticoagulation and rate control are important. Routine use of antiarrhythmic drug therapy for maintenance of sinus rhythm carries concerns of risk and limited efficacy. Catheter ablation ...
journal_title:Heart rhythm
pub_type: 杂志文章,评审
doi:10.1016/j.hrthm.2006.12.003
更新日期:2007-03-01 00:00:00
abstract:BACKGROUND:Although left cardiac sympathetic denervation (LCSD) is an effective antiarrhythmic therapy for patients with long QT syndrome (LQTS), direct evidence of reduced sympathetic activity after LCSD in humans is limited. OBJECTIVE:The purpose of this study was to assess skin sympathetic nerve activity (SKNA) in ...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2020.03.023
更新日期:2020-10-01 00:00:00
abstract:BACKGROUND:Both schizophrenia and epilepsy have been linked to increased risk of sudden cardiac death (SCD). We hypothesized that DNA variants within genes previously associated with schizophrenia and epilepsy may contribute to an increased risk of SCD. OBJECTIVE:To investigate the contribution to SCD susceptibility o...
journal_title:Heart rhythm
pub_type: 杂志文章,多中心研究
doi:10.1016/j.hrthm.2013.03.020
更新日期:2013-07-01 00:00:00
abstract:BACKGROUND:The advent of clinical next generation sequencing is rapidly changing the landscape of rare disease medicine. Molecular diagnosis of long QT syndrome (LQTS) can affect clinical management, including risk stratification and selection of pharmacotherapy on the basis of the type of ion channel affected, but res...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2014.06.030
更新日期:2014-10-01 00:00:00
abstract:BACKGROUND:A considerable rate of atrial fibrillation (AF) recurrence is one of the major limitations of pulmonary vein isolation (PVI). Although endothelin-1 (ET-1) is involved in atrial remodeling, it is unknown whether plasma ET-1 level before PVI can be used as a predictive factor for AF recurrence. OBJECTIVE:The ...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2009.02.027
更新日期:2009-06-01 00:00:00
abstract::Newer generations of pacemakers and implantable cardioverter defibrillators have enhanced diagnostic features that permit detection and storage of information about the frequency, duration, time of onset, and rate characteristics of multiple consecutive episodes of atrial tachycardia and atrial fibrillation (AF). Para...
journal_title:Heart rhythm
pub_type: 杂志文章,评审
doi:10.1016/j.hrthm.2004.03.075
更新日期:2004-07-01 00:00:00
abstract:BACKGROUND:Catheter contact is important for radiofrequency (RF) ablation. Local electrical catheter-to-tissue coupling has been described as a tool to objectively measure contact. OBJECTIVE:We hypothesized that pulmonary vein isolation (PVI) ablation using electrical coupling information (ECI) would yield higher rate...
journal_title:Heart rhythm
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.hrthm.2012.10.010
更新日期:2013-02-01 00:00:00
abstract:BACKGROUND:Watchman and Lariat left atrial appendage (LAA) occlusion devices are associated with LAA leaks postdeployment. OBJECTIVE:The purpose of this study was to compare the incidence, characteristics, and clinical significance of these leaks. METHODS:We performed a multicenter prospective observational study of ...
journal_title:Heart rhythm
pub_type: 杂志文章,多中心研究
doi:10.1016/j.hrthm.2015.03.020
更新日期:2015-07-01 00:00:00
abstract:BACKGROUND:The St. Jude Medical Riata family of implantable cardioverter-defibrillator (ICD) leads has demonstrated a high rate of externalized conductors and electrical failure. OBJECTIVE:Given similar design elements of Durata to Riata, the purpose of this study was to assess the rates of failure of the Riata ST Opt...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2013.07.050
更新日期:2013-10-01 00:00:00
abstract:BACKGROUND:The degree of QT prolongation by drug is highly variable and related to risk for polymorphic ventricular tachycardia due to drugs. OBJECTIVE:The purpose of this study was to determine factors that affect the degree of QT prolongation by drugs. METHODS:QT and QTc were measured before and after administratio...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2011.03.042
更新日期:2011-10-01 00:00:00
abstract:BACKGROUND:Patients with atrial fibrillation (AF) experience an increased risk of heart failure (HF). However, data are lacking on current trends in the risk of HF after AF. OBJECTIVE:The purpose of this study was to describe the temporal trends in HF occurrence after AF in a community cohort of patients with incident...
journal_title:Heart rhythm
pub_type: 杂志文章,多中心研究
doi:10.1016/j.hrthm.2017.01.031
更新日期:2017-06-01 00:00:00
abstract:BACKGROUND:The ionic mechanisms underlying action potential duration alternans are not established. OBJECTIVES:The purpose of this study was to explore the mechanisms underlying action potential alternans. METHODS:Computer simulations were performed using a model of a single ischemic myocyte. To emulate ischemia, ext...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2005.11.016
更新日期:2006-03-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to assess the value of T-wave alternans (TWA) following ventricular extrasystoles in predicting arrhythmia-free survival. BACKGROUND:Stratifying risk for sudden death in patients with coronary disease and moderate left ventricular (LV) dysfunction remains a challenge. We hypothe...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2004.12.010
更新日期:2005-03-01 00:00:00
abstract:BACKGROUND:Different P-wave morphologies during sinus rhythm as displayed on standard ECGs have been postulated to correspond to differences in interatrial conduction. OBJECTIVE:The purpose of this study was to evaluate the hypothesis by comparing P-wave morphologies using left atrial activation maps. METHODS:Twenty-...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2007.12.017
更新日期:2008-03-01 00:00:00
abstract:BACKGROUND:Long QT syndrome (LQTS) genetic test reports commonly exclude potentially proarrhythmic common variants such as p.Asp85Asn-KCNE1. OBJECTIVE:The purpose of this study was to determine whether a discernible phenotype is associated with p.Asp85Asn-KCNE1 and whether relatively common KCNE1 variants underlie tra...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2018.03.038
更新日期:2018-08-01 00:00:00