Dual-atria rotor modification: A comparative analysis of rotor modification and posterior wall isolation in patients with persistent and long-standing persistent atrial fibrillation

Dual-atria rotor modification: A comparative analysis of rotor modification and posterior wall isolation in patients with persistent and long-standing persistent atrial fibrillation

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) compar...

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Main Authors: Yoshifumi Okano, PhD, MD, Hironobu Tanii, MD, Katsuya Akitsu, PhD, MD, Yamato Mifune, MD, Kosuke Takeda, MD, Yuichi Moriyama, MD, Hosei Kikushima, MD, Shintaro Yao, PhD, MD, Masaya Shinohara, PhD, MD, Hirotsugu Matsumoto, RT, Kazuhito Suzuki, PhD, MD
Format: Article
Language:English
Published: Elsevier 2025-08-01
Series:Heart Rhythm O2
Subjects:
Persistent atrial fibrillation
Phase mapping
Posterior wall isolation
Right atrium
Rotor modification
Spiral waves
Online Access:http://www.sciencedirect.com/science/article/pii/S2666501825001710
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Summary: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.
ISSN:2666-5018

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