Acute and early outcomes of focal impulse and rotor modulation (FIRM)-guided rotors-only ablation in patients with nonparoxysmal atrial fibrillation

Carola Gianni, Sanghamitra Mohanty, Luigi Di Biase, Tamara Metz, Chintan Trivedi, Yalçin Gökoǧlan, Mahmut F. Güneş, Rong Bai, Amin Al-Ahmad, J. David Burkhardt, G. Joseph Gallinghouse, Rodney P. Horton, Patrick M. Hranitzky, Javier E. Sanchez, Phillipp Halbfaß, Patrick Müller, Anja Schade, Thomas Deneke, Gery F. Tomassoni, Andrea Natale

Research output: Contribution to journalArticlepeer-review

98 Scopus citations


Background Focal impulse and rotor modulation (FIRM)-guided ablation targets sites that are thought to sustain atrial fibrillation (AF). Objective The purpose of this study was to evaluate the acute and mid-term outcomes of FIRM-guided only ablation in patients with nonparoxysmal AF. Methods We prospectively enrolled patients with persistent and long-standing persistent (LSP) AF at three centers to undergo FIRM-guided only ablation. We evaluated acute procedural success (defined as AF termination, organization, or ≥10% slowing), safety (incidence of periprocedural complications), and long-term success (single-procedure freedom from atrial tachycardia [AT]/AF off antiarrhythmic drugs [AAD] after a 2-month blanking period). Results Twenty-nine patients with persistent (N = 20) and LSP (N = 9) AF underwent FIRM mapping. Rotors were presents in all patients, with a mean of 4 ± 1.2 per patient (62% were left atrial); 1 focal impulse was identified. All sources were successfully ablated, and overall acute success rate was 41% (0 AF termination, 2 AF slowing, 10 AF organization). There were no major procedure-related adverse events. After a mean 5.7 months of follow-up, single-procedure freedom from AT/AF without AADs was 17%. Conclusion In nonparoxysmal AF patients, targeted ablation of FIRM-identified rotors is not effective in obtaining AF termination, organization, or slowing during the procedure. After mid-term follow-up, the strategy of ablating FIRM-identified rotors alone did not prevent recurrence from AT/AF.

Original languageEnglish (US)
Pages (from-to)830-835
Number of pages6
JournalHeart Rhythm
Issue number4
StatePublished - Apr 1 2016


  • Atrial fibrillation
  • Catheter ablation
  • FIRM mapping
  • Rotor

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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