title: Initial independent outcomes from focal impulse and rotor modulation ablation for atrial fibrillation: multicenter FIRM registry.
abstract: BACKGROUND
  The success of pulmonary vein isolation (PVI) for atrial fibrillation (AF) may be improved if stable AF sources identified by Focal Impulse and Rotor Mapping (FIRM) are also eliminated. The long-term results of this approach are unclear outside the centers where FIRM was developed; thus, we assessed outcomes of FIRM-guided AF ablation in the first cases at 10 experienced centers.
  
  
  METHODS
  We prospectively enrolled n = 78 consecutive patients (61 ± 10 years) undergoing FIRM guided ablation for persistent (n = 48), longstanding persistent (n = 7), or paroxysmal (n = 23) AF. AF recordings from both atria with a 64-pole basket catheter were analyzed using a novel mapping system (Rhythm View(TM) ; Topera Inc., CA, USA). Identified rotors/focal sources were ablated, followed by PVI.
  
  
  RESULTS
  Each institution recruited a median of 6 patients, each of whom showed 2.3 ± 0.9 AF rotors/focal sources in diverse locations. 25.3% of all sources were right atrial (RA), and 50.0% of patients had ≥1 RA source. Ablation of all sources required a total of 16.6 ± 11.7 minutes, followed by PVI. On >1 year follow-up with a 3-month blanking period, 1 patient lost to follow-up (median time to 1st recurrence: 245 days, IQR 145-354), single-procedure freedom from AF was 87.5% (patients without prior ablation; 35/40) and 80.5% (all patients; 62/77) and similar for persistent and paroxysmal AF (P = 0.89).
  
  
  CONCLUSIONS
  Elimination of patient-specific AF rotors/focal sources produced freedom-from-AF of ≈80% at 1 year at centers new to FIRM. FIRM-guided ablation has a rapid learning curve, yielding similar results to original FIRM reports in each center's first cases.
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Miller
authors.affiliation: Heartplace, Baylor University Medical Center, Dallas, Texas, USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Kowal
authors.affiliation: Arizona Heart Institute, Phoenix, Arizona, USA.
authors.forename: Vijay
authors.initials: V
authors.lastname: Swarup
authors.affiliation: Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: James P
authors.initials: JP
authors.lastname: Daubert
authors.affiliation: Ohio State University, Columbus, Ohio, USA.
authors.forename: Emile G
authors.initials: EG
authors.lastname: Daoud
authors.affiliation: Intermountain Heart Institute, Murray, Utah, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Day
authors.affiliation: Medical College of Virginia, Richmond, Virginia.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Ellenbogen
authors.affiliation: Ohio State University, Columbus, Ohio, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Hummel
authors.affiliation: Veterans Affairs Medical Center, University of California, San Diego, California, USA.
authors.forename: Tina
authors.initials: T
authors.lastname: Baykaner
authors.affiliation: Veterans Affairs Medical Center, University of California, San Diego, California, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Krummen
authors.affiliation: Veterans Affairs Medical Center, University of California, San Diego, California, USA.
authors.forename: Sanjiv M
authors.initials: SM
authors.lastname: Narayan
authors.affiliation: Mount Sinai Medical Center, New York, USA.
authors.forename: Vivek Y
authors.initials: VY
authors.lastname: Reddy
authors.affiliation: UCLA Cardiac Arrhythmia Center, Los Angeles, California, USA.
authors.forename: Kalyanam
authors.initials: K
authors.lastname: Shivkumar
authors.affiliation: Valley Health System, New York, New York and Ridgewood, New Jersey, USA.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Steinberg
authors.affiliation: Heartplace, Baylor University Medical Center, Dallas, Texas, USA.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Wheelan
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome
keywords: FIRM-guided ablation; atrial fibrillation; catheter ablation; focal impulse; rotors