Rotor mapping: black box or very simple? The FIRM approach

Abstract

Catheter ablation has become the most common therapy in patients with atrial fibrillation (AF). However, despite significant advances in technology and operators' experience, ablation outcomes remain suboptimal, especially in patients with persistent AF. Focal impulse and rotor modulation (FIRM) represents a new technology for mapping and ablation of patient-specific AF sources. This approach is based on the concept of localized sources, which can be understood as organized rotational waves or focal impulses driving disorganized AF. Several studies, mainly single-center case series, have shown an incremental benefit in long-term outcome when adding FIRM-guided ablation to conventional pulmonary vein isolation (PVI). Therefore, the results of ongoing multicenter randomized trials are needed to support this data.

Keywords: Atrial fibrillation; Catheter ablation; Focal impulses; Pulmonary vein isolation; Rotors.