Association with the nonparoxysmal atrial fibrillation duration and outcome of ExTRa Mapping‐guided rotor ablation

BACKGROUND: Additional ablation strategies after pulmonary vein isolation (PVI) for patients with nonparoxysmal atrial fibrillation (non‐PAF) lasting ≥2 years have not been fully effective. This is presumably because of insufficient identification of non‐PAF maintenance mechanisms. In this study, we employed a novel online and real‐time phase mapping system, ExTRa Mapping, to identify and modulate rotors as one of the non‐PAF maintenance mechanisms in patients with non‐PAF sustained after PVI. We investigated the relationship between outcomes of ExTRa Mapping‐guided rotor ablation (ExTRa‐ABL) and non‐PAF duration prior to this procedure. METHODS: This study consisted of 73 non‐PAF patients (63 ± 8 years, non‐PAF duration 31 ± 37 months) who underwent the first ExTRa‐ABL in patients with non‐PAF sustained after completion of PVI. RESULTS: Freedom from non‐PAF/atrial tachycardia (AT) recurrence at 12 months after ExTRa‐ABL was achieved in 50 (69%) of patients. The non‐PAF duration prior to ExTRa‐ABL was significantly longer in patients with non‐PAF/AT recurrence after ExTRa‐ABL compared with those without (56 ± 50 vs. 19 ± 22 months, p = .001). In patients with non‐PAF duration of ≤60 months prior to ExTRa‐ABL, compared with >60 months, non‐PAF/AT‐free rate was significantly higher (68.9% vs. 23.1%, p < .001), during the follow‐up of 36 ± 18 months. CONCLUSIONS: A non‐PAF duration of ≤60 months prior to ExTRa‐ABL was associated with a better outcome. The effect of ExTRa‐ABL was considered to be limited in patients with >60 months of non‐PAF duration.