Catheter Ablation With Morphologic Repetitiveness Mapping for Persistent Atrial Fibrillation

Chin Yu Lin; Yenn Jiang Lin; Satoshi Higa; Wen Chin Tsai; Men Tzung Lo; Chia Hsin Chiang; Shih Lin Chang; Li Wei Lo; Yu Feng Hu; Tze Fan Chao; Fa Po Chung; Jo Nan Liao; Ting Yung Chang; Chen Lin; Ta Chuan Tuan; Ling Kuo; Cheng I. Wu; Chih Min Liu; Shin Huei Liu; Ming Jen Kuo; Ying Chieh Liao; Chieh Mao Chuang; Yun Yu Chen; Yu Cheng Hsieh; Shih Ann Chen

doi:10.1001/jamanetworkopen.2023.44535

Catheter Ablation With Morphologic Repetitiveness Mapping for Persistent Atrial Fibrillation

Chin Yu Lin, Yenn Jiang Lin^*, Satoshi Higa, Wen Chin Tsai, Men Tzung Lo^*, Chia Hsin Chiang, Shih Lin Chang, Li Wei Lo, Yu Feng Hu, Tze Fan Chao, Fa Po Chung, Jo Nan Liao, Ting Yung Chang, Chen Lin, Ta Chuan Tuan, Ling Kuo, Cheng I. Wu, Chih Min Liu, Shin Huei Liu, Ming Jen KuoYing Chieh Liao, Chieh Mao Chuang, Yun Yu Chen, Yu Cheng Hsieh, Shih Ann Chen

^*Corresponding author for this work

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

Abstract

IMPORTANCE Catheter ablation for persistent atrial fibrillation (AF) has shown limited success. OBJECTIVE To determine whether AF drivers could be accurately identified by periodicity and similarity (PRISM) mapping ablation results for persistent AF when added to pulmonary vein isolation (PVI). DESIGN, SETTING, AND PARTICIPANTS This prospective randomized clinical trial was performed between June 1, 2019, and December 31, 2020, and included patients with persistent AF enrolled in 3 centers across Asia. Data were analyzed on October 1, 2022. INTERVENTION Patients were assigned to the PRISM-guided approach (group 1) or the conventional approach (group 2) at a 1:1 ratio. MAIN OUTCOMES AND MEASURES The primary outcome was freedom from AF or other atrial arrhythmia for longer than 30 seconds at 6 and 12 months. RESULTS A total of 170 patients (mean [SD] age, 62.0 [12.3] years; 136 men [80.0%]) were enrolled (85 patients in group 1 and 85 patients in group 2). More group 1 patients achieved freedom from AF at 12 months compared with group 2 patients (60 [70.6%] vs 40 [47.1%]). Multivariate analysis indicated that the PRISM-guided approach was associated with freedom from the recurrence of atrial arrhythmia (hazard ratio, 0.53 [95% CI, 0.33-0.85]). CONCLUSIONS AND RELEVANCE The waveform similarity and recurrence pattern derived from high-density mapping might provide an improved guiding approach for ablation of persistent AF. Compared with the conventional procedure, this novel specific substrate ablation strategy reduced the frequency of recurrent AF and increased the likelihood of maintenance of sinus rhythm.

Original language	English
Pages (from-to)	E2344535
Journal	JAMA network open
Volume	6
Issue number	11
DOIs	https://doi.org/10.1001/jamanetworkopen.2023.44535
State	Published - 22 Nov 2023

Access to Document

10.1001/jamanetworkopen.2023.44535

Cite this

Lin, C. Y., Lin, Y. J., Higa, S., Tsai, W. C., Lo, M. T., Chiang, C. H., Chang, S. L., Lo, L. W., Hu, Y. F., Chao, T. F., Chung, F. P., Liao, J. N., Chang, T. Y., Lin, C., Tuan, T. C., Kuo, L., Wu, C. I., Liu, C. M., Liu, S. H., ... Chen, S. A. (2023). Catheter Ablation With Morphologic Repetitiveness Mapping for Persistent Atrial Fibrillation. JAMA network open, 6(11), E2344535. https://doi.org/10.1001/jamanetworkopen.2023.44535

@article{9aabcfc13c394a939dacf40c13e06e10,

title = "Catheter Ablation With Morphologic Repetitiveness Mapping for Persistent Atrial Fibrillation",

abstract = "IMPORTANCE Catheter ablation for persistent atrial fibrillation (AF) has shown limited success. OBJECTIVE To determine whether AF drivers could be accurately identified by periodicity and similarity (PRISM) mapping ablation results for persistent AF when added to pulmonary vein isolation (PVI). DESIGN, SETTING, AND PARTICIPANTS This prospective randomized clinical trial was performed between June 1, 2019, and December 31, 2020, and included patients with persistent AF enrolled in 3 centers across Asia. Data were analyzed on October 1, 2022. INTERVENTION Patients were assigned to the PRISM-guided approach (group 1) or the conventional approach (group 2) at a 1:1 ratio. MAIN OUTCOMES AND MEASURES The primary outcome was freedom from AF or other atrial arrhythmia for longer than 30 seconds at 6 and 12 months. RESULTS A total of 170 patients (mean [SD] age, 62.0 [12.3] years; 136 men [80.0%]) were enrolled (85 patients in group 1 and 85 patients in group 2). More group 1 patients achieved freedom from AF at 12 months compared with group 2 patients (60 [70.6%] vs 40 [47.1%]). Multivariate analysis indicated that the PRISM-guided approach was associated with freedom from the recurrence of atrial arrhythmia (hazard ratio, 0.53 [95% CI, 0.33-0.85]). CONCLUSIONS AND RELEVANCE The waveform similarity and recurrence pattern derived from high-density mapping might provide an improved guiding approach for ablation of persistent AF. Compared with the conventional procedure, this novel specific substrate ablation strategy reduced the frequency of recurrent AF and increased the likelihood of maintenance of sinus rhythm.",

author = "Lin, {Chin Yu} and Lin, {Yenn Jiang} and Satoshi Higa and Tsai, {Wen Chin} and Lo, {Men Tzung} and Chiang, {Chia Hsin} and Chang, {Shih Lin} and Lo, {Li Wei} and Hu, {Yu Feng} and Chao, {Tze Fan} and Chung, {Fa Po} and Liao, {Jo Nan} and Chang, {Ting Yung} and Chen Lin and Tuan, {Ta Chuan} and Ling Kuo and Wu, {Cheng I.} and Liu, {Chih Min} and Liu, {Shin Huei} and Kuo, {Ming Jen} and Liao, {Ying Chieh} and Chuang, {Chieh Mao} and Chen, {Yun Yu} and Hsieh, {Yu Cheng} and Chen, {Shih Ann}",

year = "2023",

month = nov,

day = "22",

doi = "10.1001/jamanetworkopen.2023.44535",

language = "English",

volume = "6",

pages = "E2344535",

journal = "JAMA network open",

issn = "2574-3805",

publisher = "American Medical Association",

number = "11",

}

Lin, CY, Lin, YJ, Higa, S, Tsai, WC, Lo, MT, Chiang, CH, Chang, SL , Lo, LW , Hu, YF, Chao, TF, Chung, FP, Liao, JN, Chang, TY, Lin, C, Tuan, TC, Kuo, L, Wu, CI, Liu, CM, Liu, SH, Kuo, MJ, Liao, YC, Chuang, CM, Chen, YY, Hsieh, YC & Chen, SA 2023, 'Catheter Ablation With Morphologic Repetitiveness Mapping for Persistent Atrial Fibrillation', JAMA network open, vol. 6, no. 11, pp. E2344535. https://doi.org/10.1001/jamanetworkopen.2023.44535

TY - JOUR

T1 - Catheter Ablation With Morphologic Repetitiveness Mapping for Persistent Atrial Fibrillation

AU - Lin, Chin Yu

AU - Lin, Yenn Jiang

AU - Higa, Satoshi

AU - Tsai, Wen Chin

AU - Lo, Men Tzung

AU - Chiang, Chia Hsin

AU - Chang, Shih Lin

AU - Lo, Li Wei

AU - Hu, Yu Feng

AU - Chao, Tze Fan

AU - Chung, Fa Po

AU - Liao, Jo Nan

AU - Chang, Ting Yung

AU - Lin, Chen

AU - Tuan, Ta Chuan

AU - Kuo, Ling

AU - Wu, Cheng I.

AU - Liu, Chih Min

AU - Liu, Shin Huei

AU - Kuo, Ming Jen

AU - Liao, Ying Chieh

AU - Chuang, Chieh Mao

AU - Chen, Yun Yu

AU - Hsieh, Yu Cheng

AU - Chen, Shih Ann

PY - 2023/11/22

Y1 - 2023/11/22

N2 - IMPORTANCE Catheter ablation for persistent atrial fibrillation (AF) has shown limited success. OBJECTIVE To determine whether AF drivers could be accurately identified by periodicity and similarity (PRISM) mapping ablation results for persistent AF when added to pulmonary vein isolation (PVI). DESIGN, SETTING, AND PARTICIPANTS This prospective randomized clinical trial was performed between June 1, 2019, and December 31, 2020, and included patients with persistent AF enrolled in 3 centers across Asia. Data were analyzed on October 1, 2022. INTERVENTION Patients were assigned to the PRISM-guided approach (group 1) or the conventional approach (group 2) at a 1:1 ratio. MAIN OUTCOMES AND MEASURES The primary outcome was freedom from AF or other atrial arrhythmia for longer than 30 seconds at 6 and 12 months. RESULTS A total of 170 patients (mean [SD] age, 62.0 [12.3] years; 136 men [80.0%]) were enrolled (85 patients in group 1 and 85 patients in group 2). More group 1 patients achieved freedom from AF at 12 months compared with group 2 patients (60 [70.6%] vs 40 [47.1%]). Multivariate analysis indicated that the PRISM-guided approach was associated with freedom from the recurrence of atrial arrhythmia (hazard ratio, 0.53 [95% CI, 0.33-0.85]). CONCLUSIONS AND RELEVANCE The waveform similarity and recurrence pattern derived from high-density mapping might provide an improved guiding approach for ablation of persistent AF. Compared with the conventional procedure, this novel specific substrate ablation strategy reduced the frequency of recurrent AF and increased the likelihood of maintenance of sinus rhythm.

AB - IMPORTANCE Catheter ablation for persistent atrial fibrillation (AF) has shown limited success. OBJECTIVE To determine whether AF drivers could be accurately identified by periodicity and similarity (PRISM) mapping ablation results for persistent AF when added to pulmonary vein isolation (PVI). DESIGN, SETTING, AND PARTICIPANTS This prospective randomized clinical trial was performed between June 1, 2019, and December 31, 2020, and included patients with persistent AF enrolled in 3 centers across Asia. Data were analyzed on October 1, 2022. INTERVENTION Patients were assigned to the PRISM-guided approach (group 1) or the conventional approach (group 2) at a 1:1 ratio. MAIN OUTCOMES AND MEASURES The primary outcome was freedom from AF or other atrial arrhythmia for longer than 30 seconds at 6 and 12 months. RESULTS A total of 170 patients (mean [SD] age, 62.0 [12.3] years; 136 men [80.0%]) were enrolled (85 patients in group 1 and 85 patients in group 2). More group 1 patients achieved freedom from AF at 12 months compared with group 2 patients (60 [70.6%] vs 40 [47.1%]). Multivariate analysis indicated that the PRISM-guided approach was associated with freedom from the recurrence of atrial arrhythmia (hazard ratio, 0.53 [95% CI, 0.33-0.85]). CONCLUSIONS AND RELEVANCE The waveform similarity and recurrence pattern derived from high-density mapping might provide an improved guiding approach for ablation of persistent AF. Compared with the conventional procedure, this novel specific substrate ablation strategy reduced the frequency of recurrent AF and increased the likelihood of maintenance of sinus rhythm.

UR - http://www.scopus.com/inward/record.url?scp=85177665411&partnerID=8YFLogxK

U2 - 10.1001/jamanetworkopen.2023.44535

DO - 10.1001/jamanetworkopen.2023.44535

M3 - Article

C2 - 37991761

AN - SCOPUS:85177665411

SN - 2574-3805

VL - 6

SP - E2344535

JO - JAMA network open

JF - JAMA network open

IS - 11

ER -

Catheter Ablation With Morphologic Repetitiveness Mapping for Persistent Atrial Fibrillation

Abstract

Access to Document

Other files and links

Fingerprint

Cite this