Type and rate of atrial fibrillation termination due to rotational activity ablation combined with pulmonary vein isolation
Atrial fibrillation (AF) is the most common arrhythmia resulting in the reduction of quality of life, functional clinical status and overall survival.1 Although several basic and clinical studies demonstrated that pulmonary vein isolation (PVI) is superior to medical therapy in AF management, the underlying mechanism of PVI efficacy is still not completely clear.3 Haïssaguerre et al. detected that pulmonary veins (PVs) have a role in triggering of AF. However, our knowledge about AF drivers responsible for AF maintenance is still far from being complete.7 One can assume if a driver of AF is eliminated then it should result in termination and/or noninducibility of the arrhythmia. PVI provides a generic anatomical approach to eliminate AF triggers and also the susceptive driver(s) in PVs as well. Recently, the focal impulse and rotor modulation (FIRM) mapping became available, which aims to identify areas of the atria functioning as patient‐specific AF driver(s).8 Targeting these atrial substrates ensures a patient‐tailored ablation strategy for AF elimination.11 Despite this, the clinical outcome data of AF termination after FIRM‐guided ablation are still controversial.9 The aim of the current study was to evaluate the timing and rate of AF termination using ablation of rotational activity (RoAc) detected by FIRM mapping combined with conventional PVI in persistent AF patients.