Acute termination of human atrial fibrillation by identification and catheter ablation of localized rotors and sources: First multicenter experience of focal impulse and rotor modulation (FIRM) ablation

Kalyanam Shivkumar, Kenneth A. Ellenbogen, John D. Hummel, John Miller, Jonathan S. Steinberg

Research output: Contribution to journalArticle

92 Citations (Scopus)

Abstract

Introduction: Catheter ablation of atrial fibrillation (AF) currently relies on eliminating triggers, and no reliable method exists to map the arrhythmia itself to identify ablation targets. The aim of this multicenter study was to define the use of Focal Impulse and Rotor Modulation (FIRM) for identifying ablation targets. Methods: We prospectively enrolled the first (n = 14, 11 males) consecutive patients undergoing FIRM-guided ablation for persistent (n = 11) and paroxysmal AF at 5 centers. A 64-pole basket catheter was used for panoramic right and left atrial mapping during AF. AF electrograms were analyzed using a novel system to identify sustained rotors (spiral waves), or focal beats (centrifugal activation to surrounding atrium). Ablation was performed first at identified sources. The primary endpoints were acute AF termination or organization (>10% cycle length prolongation). Conventional ablation was performed only after FIRM-guided ablation. Results: Twelve out of 14 cases were mapped. AF sources were demonstrated in all patients (average of 1.9 ± 0.8 per patient). Sources were left atrial in 18 cases, and right atrial in 5 cases, and 21/23 were rotors. FIRM-guided ablation achieved the acute endpoint in all patients, consisting of AF termination in n = 8 (4.9 ± 3.9 minutes at the primary source), and organization in n = 4. Total FIRM time for all patients was 12.3 ± 8.6 minutes. Conclusions: FIRM-guided ablation revealed localized AF rotors/focal sources in patients with paroxysmal, persistent and longstanding persistent AF. Brief targeted FIRM-guided ablation at a priori identified sites terminated or substantially organized AF in all cases prior to any other ablation.

Original languageEnglish
Pages (from-to)1277-1285
Number of pages9
JournalJournal of Cardiovascular Electrophysiology
Volume23
Issue number12
DOIs
StatePublished - Dec 2012

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Catheter Ablation
Atrial Fibrillation
Cardiac Electrophysiologic Techniques
Multicenter Studies
Cardiac Arrhythmias
Catheters

Keywords

  • atrial fibrillation
  • catheter ablation
  • FIRM
  • rotors
  • spiral waves

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Acute termination of human atrial fibrillation by identification and catheter ablation of localized rotors and sources : First multicenter experience of focal impulse and rotor modulation (FIRM) ablation. / Shivkumar, Kalyanam; Ellenbogen, Kenneth A.; Hummel, John D.; Miller, John; Steinberg, Jonathan S.

In: Journal of Cardiovascular Electrophysiology, Vol. 23, No. 12, 12.2012, p. 1277-1285.

Research output: Contribution to journalArticle

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