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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| Format: | Article |
| Language: | English |
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Elsevier
2025-08-01
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| Series: | Heart Rhythm O2 |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666501825001710 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Yoshifumi Okano, PhD, MD |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-b9a5d2fb99f34bb28137e50bc56a2b34 |
| institution | Kabale University |
| issn | 2666-5018 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heart Rhythm O2 |
| spelling | doaj-art-b9a5d2fb99f34bb28137e50bc56a2b342025-08-24T05:14:46ZengElsevierHeart Rhythm O22666-50182025-08-01681147115810.1016/j.hroo.2025.05.021Dual-atria rotor modification: A comparative analysis of rotor modification and posterior wall isolation in patients with persistent and long-standing persistent atrial fibrillationYoshifumi Okano, PhD, MD0Hironobu Tanii, MD1Katsuya Akitsu, PhD, MD2Yamato Mifune, MD3Kosuke Takeda, MD4Yuichi Moriyama, MD5Hosei Kikushima, MD6Shintaro Yao, PhD, MD7Masaya Shinohara, PhD, MD8Hirotsugu Matsumoto, RT9Kazuhito Suzuki, PhD, MD10Division of Cardiology, Tokyo Metropolitan Ohkubo Hospital, Shinjyuku-ku, Tokyo, Japan; Address reprint requests and correspondence: Yoshifumi Okano, Tokyo Metropolitan Ohkubo Hospital, 2-44-1, Kabuki-cho, Shinjyuku-ku, Tokyo 160, Japan.Division of Cardiology, Tokyo Metropolitan Ohkubo Hospital, Shinjyuku-ku, Tokyo, JapanDivision of Cardiology, Tokyo Metropolitan Ohkubo Hospital, Shinjyuku-ku, Tokyo, JapanDivision of Cardiology, Tokyo Metropolitan Ohkubo Hospital, Shinjyuku-ku, Tokyo, JapanDivision of Cardiology, Tokyo Metropolitan Ohkubo Hospital, Shinjyuku-ku, Tokyo, JapanDivision of Cardiology, Tokyo Metropolitan Ohkubo Hospital, Shinjyuku-ku, Tokyo, JapanDivision of Cardiovascular Medicine, Toho University Omori Medical Center, Ohta-ku, Tokyo, JapanDivision of Cardiovascular Medicine, Toho University Omori Medical Center, Ohta-ku, Tokyo, JapanDivision of Cardiovascular Medicine, Toho University Omori Medical Center, Ohta-ku, Tokyo, JapanDepartment of Radiology, Tokyo Metropolitan Ohkubo Hospital, Shinjyuku-ku, Tokyo, JapanDivision of Cardiology, Tokyo Metropolitan Ohkubo Hospital, Shinjyuku-ku, Tokyo, JapanBackground: 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.http://www.sciencedirect.com/science/article/pii/S2666501825001710Persistent atrial fibrillationPhase mappingPosterior wall isolationRight atriumRotor modificationSpiral waves |
| spellingShingle | 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 Dual-atria rotor modification: A comparative analysis of rotor modification and posterior wall isolation in patients with persistent and long-standing persistent atrial fibrillation Heart Rhythm O2 Persistent atrial fibrillation Phase mapping Posterior wall isolation Right atrium Rotor modification Spiral waves |
| title | Dual-atria rotor modification: A comparative analysis of rotor modification and posterior wall isolation in patients with persistent and long-standing persistent atrial fibrillation |
| title_full | Dual-atria rotor modification: A comparative analysis of rotor modification and posterior wall isolation in patients with persistent and long-standing persistent atrial fibrillation |
| title_fullStr | Dual-atria rotor modification: A comparative analysis of rotor modification and posterior wall isolation in patients with persistent and long-standing persistent atrial fibrillation |
| title_full_unstemmed | Dual-atria rotor modification: A comparative analysis of rotor modification and posterior wall isolation in patients with persistent and long-standing persistent atrial fibrillation |
| title_short | Dual-atria rotor modification: A comparative analysis of rotor modification and posterior wall isolation in patients with persistent and long-standing persistent atrial fibrillation |
| title_sort | dual atria rotor modification a comparative analysis of rotor modification and posterior wall isolation in patients with persistent and long standing persistent atrial fibrillation |
| topic | Persistent atrial fibrillation Phase mapping Posterior wall isolation Right atrium Rotor modification Spiral waves |
| url | http://www.sciencedirect.com/science/article/pii/S2666501825001710 |
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