title: Impact of rotor temperospatial stability on acute and one-year atrial fibrillation ablation outcomes.
abstract: BACKGROUND
  The utility of rotor ablation using commercially available systems as an adjunct to pulmonary vein isolation (PVI) is controversial. Variable results may stem from heterogeneous practice patterns. We investigated whether a prespecified protocol to determine temperospatial rotor stability improved acute and intermediate outcomes following rotor ablation.
  
  
  OBJECTIVE
  Protocolized rotor mapping and ablation, with prespecified metrics to determine temporal rotor stability prior to ablation, will improve short- and long-term PVI/rotor ablation outcomes.
  
  
  METHODS
  Patients undergoing PVI plus rotor ablation at Johns Hopkins during 2015 were included. The first cohort underwent rotor mapping and ablation at the operator's discretion, whereas the second cohort underwent protocolized rotor mapping, with ablation limited to temperospatially stable rotors. Both cohorts underwent PVI. Acute results (rotor elimination, atrial fibrillation [AF] termination), procedural data, and 1-year outcomes were assessed.
  
  
  RESULTS
  Twenty-seven patients underwent ablation (mean age, 64.4 ± 9 years, male 81.5%, persistent AF 85.2%, long-standing persistent AF 14.8%, mean AF duration 4.4 ± 4 years, repeat cases 51.8%, and mean LA size 4.6 ± 0.8 cm). In the protocolized cohort, rotors were reproducible in 83% (10/12) of cases in at least 1 chamber. Acute rhythm change was achieved in 8/27 (29.6%) patients. Sinus rhythm on presentation (62.5% vs 15.8%, P = 0.03) and higher total targeted rotors (3.8 ± 1.7 vs 2.5 ± 1.0, P = 0.02) predicted acute change. At 12 months, freedom from AF/atrial tachycardia was achieved in 5/15 (33.3%) patients in the first cohort and 5/11 patients in the protocolized cohort (45.5%; P = 0.53 for comparison).
  
  
  CONCLUSIONS
  Acute and intermediate results did not change with protocolized mapping designed to identify temperospatially stable rotors. Outcomes at 12 months were similar in both groups.
authors.affiliation: Johns Hopkins Hospital Heart and Vascular Institute, Division of Cardiology, Department of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Balouch
authors.affiliation: Johns Hopkins Hospital Heart and Vascular Institute, Division of Cardiology, Department of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Esra
authors.initials: E
authors.lastname: Gucuk Ipek
authors.affiliation: Johns Hopkins Hospital Heart and Vascular Institute, Division of Cardiology, Department of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Chrispin
authors.affiliation: Johns Hopkins Hospital Heart and Vascular Institute, Division of Cardiology, Department of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Rizma J
authors.initials: RJ
authors.lastname: Bajwa
authors.affiliation: Johns Hopkins Hospital Heart and Vascular Institute, Division of Cardiology, Department of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Tarek
authors.initials: T
authors.lastname: Zghaib
authors.affiliation: Johns Hopkins Hospital Heart and Vascular Institute, Division of Cardiology, Department of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Berger
authors.affiliation: Johns Hopkins Hospital Heart and Vascular Institute, Division of Cardiology, Department of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ashikaga
authors.affiliation: Johns Hopkins Hospital Heart and Vascular Institute, Division of Cardiology, Department of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Saman
authors.initials: S
authors.lastname: Nazarian
authors.affiliation: Johns Hopkins Hospital Heart and Vascular Institute, Division of Cardiology, Department of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Marine
authors.affiliation: Johns Hopkins Hospital Heart and Vascular Institute, Division of Cardiology, Department of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.affiliation: Johns Hopkins Hospital Heart and Vascular Institute, Division of Cardiology, Department of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: David D
authors.initials: DD
authors.lastname: Spragg
mesh_terms: D000208:Acute Disease; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Arrhythmia; Atrial fibrillation; Catheter ablation; Focal impulse and rotor modulation