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  • Two analyses were performed. First, any source ablation was assigned if ��1 source was ablated, and no source ablation was assigned otherwise. Conventional ablation was left atrial, so that this analysis could be performed in all patients (FIRM-blinded and -guided) who all received left atrial FIRM maps. Second, we measured FIRM dose response by assigning all source ablation (e.g., 3 of 3 concurrent sources), some source ablation (e.g., 2 of 3 sources ablated), and no source ablation. Because of potential right atrial AF sources, this secondary analysis was performed only in patients with biatrial FIRM maps. Assignments were performed independently by 4 of the authors (S.M.N., D.E.K., K.S., and J.M.M.), and disputes were resolved using consensus. Follow-up for arrhythmia recurrence Selleck Rapamycin met or exceeded guidelines (23). In the first 3 months post-ablation, antiarrhythmic medications were continued and cardioversion performed if indicated, but neither repeat ablation nor cross-overs were permitted. Subjects were then evaluated quarterly for up to 24 months. Arrhythmia recurrence was detected using continuous implanted electrocardiographic (ECG) monitors when consent Bleomycin was obtained (Reveal XT, Medtronic, Minneapolis, Minnesota) after U.S. approval in 2009 (Fig. 1A), or clinical pacemaker/defibrillator. Remaining subjects received external Holter or event monitors each quarter and also at the time of any symptoms. The primary long-term efficacy endpoint was freedom from AF after the FIRM-mapping procedure, defined as <1% burden on continuous implanted ECG monitors (actual burden: 0.1 �� 0.2%, as presented in CONFIRM [ 15]), or AF <30 s on intermittent monitors ( 8). Secondary efficacy measures included freedom from all atrial arrhythmias, and outcomes in patients at first ablation. Four patients in the CONFIRM trial were lost to <a href="">MG-132 concentration follow-up ( 15). Continuous data are represented as mean �� SD or median (interquartile range [IQR]) as appropriate. Normality was evaluated using the Kolmogorov-Smirnov test. Comparisons between the two groups were made with the Student t test and summarized with mean �� SD for independent samples if normally distributed or, if not normally distributed, evaluated using the Mann-Whitney U test and summarized with median (IQR). Nominal values are expressed as n (%) and compared using the Fisher exact test. Associations between continuous variables were evaluated using Spearman correlation. Interobserver agreement in assigning source ablation (S.M.N., D.E.K., K.S., and J.M.M.) was measured using the kappa score.

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