Focal Impulse and Rotor Modulation for the Treatment of Atrial Fibrillation: Locations and 1 Year Outcomes of Human Rotors Identified Using a 64‐Electrode Basket Catheter

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Atrial fibrillation (AF) is currently the most prevalent sustained cardiac arrhythmia worldwide. Catheter ablation for AF has been established as an effective treatment strategy, particularly for paroxysmal AF (PAF).1 However, recurrence rates during long‐term follow‐up remain high, particularly in patients with persistent or longstanding persistent AF.3
Although pulmonary vein isolation (PVI) is currently the gold standard for the treatment of AF, the pathophysiology of AF is still controversial.4 The pulmonary veins (PV) and PV antrum have been identified as substrates for the initiation and perpetuation of AF in patients with PAF and early‐persistent AF;1 however, mechanisms that sustain AF remain undefined in the majority of patients with persistent AF.
Recently, the novel concept of rapidly activation spiral waves, or “rotors” perpetuating AF has been described6 and the focal impulse and rotor modulation (FIRM) hypothesis has led to the development of several different intra‐cardiac and body‐surface FIRM mapping systems. These systems use computational mapping to localize rotors, which can then be eliminated by catheter ablation.
We present our experiences of FIRM ablation using a 64‐electrode basket catheter (FIRMap™, Topera, Palo Alto, CA, USA) and computational mapping system (RhythmView™, Topera) and evaluate the feasibility and effectiveness of FIRM in conjunction with circumferential PVI in patients with paroxysmal and persistent AF. To the best of our knowledge, this is one of the first studies from an independent center to report the initial experiences using this novel rotor mapping system.
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