Abstract
BACKGROUND-AIMS: Recently, the etiopathogenetic role of rotational activity (RotAct) in atrial fibrillation (AF) has been proposed. We designed a prospective multicenter study using CARTO Finder to evaluate the presence/distribution of RotActs in persistent AF (persAF), pulmonary vein isolation (PVI)influences on RotActs, and the impact of its elimination on top of PVI on procedural outcomes. METHODS: For this study, 76 patients with pers AF ablation were enrolled. Procedural steps involved (1) using a CARTO-Finder map to look for RotActs (physician blinded); (2) PVI; (3) using a new map to look for residual/new RotActs; (4) ablation of RotActs, if present; (5) and finally using a new map to confirm RotAct elimination. Populations were divided based on the presence or absence of structural heart disease (Group I and II) and the presence or absence (R+ and R-) of RotActs before PVI. Presence, number, and distribution of RotAct at STEP 1, the impact of PVI on RotAct at STEP 3, and maintenance of sinus rhythm (SR) during follow-up were evaluated. 56 AF patients undergoing standard ablation protocol were included as a control group. RESULTS: RotAct was identified in 29 (38%) patients at STEP1. RotAct did not differ between GI and GII patients. PVI significantly modified the number and localization of RotActs (p = 0.012). RotActs which were present at STEP 1 were different after PVI, with disappearance in 18 and new appearance in 5 patients. 71 patients completed a mean 13 ± 6 months follow-up and 91.5% were in stable SR. No difference in relapses was seen between R + and R- and GI and GII. RotAct ablation significantly reduced arrhythmia relapse during the follow-up compared to the control group (freedom from arrhythmia 91.5% vs. 78.6%, p = 0.025). CONCLUSION: RotAct was present in 38% in persAF patients. PVI influenced the number and distribution of RotActs. A tailored ablation strategy provided a high success rate (91.5%) at the follow-up.