Impact of Rotor Ablation in Non-Paroxysmal AF Patients: Results from a Randomized Trial (OASIS).

Abstract Few studies have reported focal impulse and rotor modulation (FIRM)-guided ablation to be superior to PV isolation (PVAI) in persistent (PeAF) and long-standing persistent atrial fibrillation (LSPAF) patients, but none of these trials were randomized. We compared the efficacy of FIRM ablation with or without PVAI vs PVAI plus non-PV trigger ablation in PeAF and LSPAF patients. Non-paroxysmal AF patients undergoing first ablation were randomized (1:1:1) to FIRM only (group 1), FIRM+ PVAI (group 2) or PVAI+ posterior wall (PW) +non-PV trigger ablation (group 3). Freedom from atrial tachycardia (AT)/AF was the primary endpoint. Secondary endpoint included acute procedural success, defined as AF termination or ≥10% slowing or organization into AT. Total of 113 patients were enrolled at 3 centers; 29 in group 1 and 42 in group 2 and 3 each. Enrollment in group 1 was terminated early for futility. Focal drivers or rotors were detected in all group 1 and 2 patients with a mean of 4±1.2 and 4.2± 1.7 per patient in respective groups. Procedure time was 222±49, 233± 48 and 131± 51 minutes in groups 1, 2 and 3 (p