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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EIn patients with paroxysmal atrial fibrillation (PAF), disease can be eliminated by targeting ablation to its primary sustaining mechanism alone without the need to ablate triggers. This is the conclusion of the Precise Rotor Elimination without Concomitant pulmonary vein Isolation for the Successful Elimination of Paroxysmal Atrial Fibrillation study [PRECISE-PAF; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01248156\u0026amp;atom=%2Fspmdc%2F13%2F3%2F15.atom\u0022\u003ENCT01248156\u003C\/a\u003E] presented in a late-breaking clinical trial session.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EIn patients with paroxysmal atrial fibrillation (PAF), disease can be eliminated by targeting ablation to its primary sustaining mechanism alone without the need to ablate triggers. This is the conclusion of the Precise Rotor Elimination without Concomitant pulmonary vein Isolation for the Successful Elimination of Paroxysmal Atrial Fibrillation study [PRECISE-PAF; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01248156\u0026amp;atom=%2Fspmdc%2F13%2F3%2F15.atom\u0022\u003ENCT01248156\u003C\/a\u003E] presented in a late-breaking clinical trial session.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe study results also confirm recently published evidence that the primary sustaining mechanisms of PAF is by stable rotors and focal sources revealed by Focal Impulse and Rotor Map (FIRM) in patient-specific bi-atrial locations [Narayan SM et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2012], and offers data that elimination of rotors or focal sources either directly by FIRM-guided ablation, or coincidentally when anatomical ablation passes through them, may explain the success of different AF ablation approaches [Narayan SM et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2013. In press].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ESanjiv M. Narayan, MD, PhD, University of California, San Diego School of Medicine, Veterans Affairs Medical Center, San Diego, California, USA, and colleagues undertook the PRECISE-PAF trial to test their hypothesis that prospective targeted ablation of stable rotors and focal sources alone would eliminate PAF over the long term without the need for pulmonary vein isolation (PVI).\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe study included 31 consecutive PAF patients undergoing FIRM-guided ablation in five centers in the United States. Patients included in the study were aged \u0026gt;21 years, had indications for PAF ablation, discontinued antiarrhythmics \u0026gt;5 half-lives, and amiodarone \u0026gt;30 days. The only patients excluded were those unable or unwilling to provide informed consent. The primary endpoint was single procedure freedom from AF.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EMost of the study participants were male (n=28); the average age was 59 years; AF had been present for \u223c4 years; the average CHADS\u003Csub\u003E2\u003C\/sub\u003E score was 1.5; and 38.7% (n=12) had a CHADS\u003Csub\u003E2\u003C\/sub\u003E \u0026gt;2. Overall, 74.2% (n=23) had hypertension and 32.3% (n=10) had coronary disease.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThe primary endpoints of the study were acute elimination of diagnosed AF rotors and focal sources based on repeated mapping, as well as long-term freedom of AF (ie, using standard criteria defined as \u0026lt;30 seconds on external intermittent monitors or \u0026lt;1% in patients with continuous monitoring). Monitoring was done quarterly and antiarrhythmic drugs were discontinued after a 90-day blanking period.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EFor each patient, the investigators delivered FIRM-guided ablation at each source to achieve termination of AF with noninducibility or to eliminate sources on repeat FIRM-maps. Residual tachycardias were also ablated. PVI was not done.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EThe study found that stable rotors and focal sources arose in all 31 patients, with 2.5 AF rotor\/focal sources per patient. Overall, the sources arose in the left atrium in 66.3% of the patients and in the right atrium in 33.7%.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EMedian FIRM-guided ablation was 17.4\u00b18.2 minutes, and total case ablation including typical atrial flutter ablation, was a median of 22.7\u00b19.1 minutes. Although PVI showed potential in all patients, they were not isolated.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EOn follow-up for a median of 223 days, using more rigorous monitoring than typically used in AF trials, 82.6% of patients were free from AF after a single FIRM-guided ablation procedure. This compares favorably with the results from prior studies of PVI that provided 50% to 60% single procedure success rates (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/3\/15\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Single Procedure Freedom From Atrial Fibrillation in the PRECISE-PAF Trial\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1336917981\u0022 data-figure-caption=\u0022Single Procedure Freedom From Atrial Fibrillation in the PRECISE-PAF Trial\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/3\/15\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/3\/15\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/3\/15\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13164\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-12\u0022 class=\u0022first-child\u0022\u003ESingle Procedure Freedom From Atrial Fibrillation in the PRECISE-PAF Trial\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from SM Narayan, MD, PhD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-13\u0022\u003EDr. Narayan concluded that the study confirms that PAF is a substrate-based disease. Accordingly, these results show that FIRM-guided ablation of stable rotors and focal sources can eliminate PAF without the need to eliminate triggers (PVI). This is in line with ablation for most other arrhythmias.\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003ELimitations of the study highlighted by the investigators included the use of current mapping baskets that were suboptimal, the single-arm design of the study, the need for larger sample size and longer follow-up, and the focus only on PAF.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/3\/15.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nznz41\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznz41\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}