title: Quantitative analysis of localized sources identified by focal impulse and rotor modulation mapping in atrial fibrillation.
abstract: BACKGROUND
  New approaches to ablation of atrial fibrillation (AF) include focal impulse and rotor modulation (FIRM) mapping, and initial results reported with this technique have been favorable. We sought to independently evaluate the approach by analyzing quantitative characteristics of atrial electrograms used to identify rotors and describe acute procedural outcomes of FIRM-guided ablation.
  
  
  RESULTS
  All FIRM-guided ablation procedures (n=24; 50% paroxysmal) at University of California, Los Angeles Medical Center were included for analysis. During AF, unipolar atrial electrograms collected from a 64-pole basket catheter were used to construct phase maps and identify putative AF sources. These sites were targeted for ablation, in conjunction with pulmonary vein isolation in most patients (n=19; 79%). All patients had rotors identified (mean, 2.3±0.9 per patient; 72% in left atrium). Prespecified acute procedural end point was achieved in 12 of 24 (50%) patients: AF termination (n=1), organization (n=3), or >10% slowing of AF cycle length (n=8). Basket electrodes were within 1 cm of 54% of left atrial surface area, and a mean of 31 electrodes per patient showed interpretable atrial electrograms. Offline analysis revealed no differences between rotor and distant sites in dominant frequency or Shannon entropy. Electroanatomic mapping showed no rotational activation at FIRM-identified rotor sites in 23 of 24 patients (96%).
  
  
  CONCLUSIONS
  FIRM-identified rotor sites did not exhibit quantitative atrial electrogram characteristics expected from rotors and did not differ quantitatively from surrounding tissue. Catheter ablation at these sites, in conjunction with pulmonary vein isolation, resulted in AF termination or organization in a minority of patients (4/24; 17%). Further validation of this approach is necessary.
authors: From the UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at University of California, Los Angeles (P.B., E.B., P.F., M.S., R.T., K.S., R.M.); and International Heart Institute, Loma Linda University Medical Center, CA (R.M.).
authors: Peyman
authors: P
authors: Benharash
authors: From the UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at University of California, Los Angeles (P.B., E.B., P.F., M.S., R.T., K.S., R.M.); and International Heart Institute, Loma Linda University Medical Center, CA (R.M.). ebuch@mednet.ucla.edu.
authors: Eric
authors: E
authors: Buch
authors: From the UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at University of California, Los Angeles (P.B., E.B., P.F., M.S., R.T., K.S., R.M.); and International Heart Institute, Loma Linda University Medical Center, CA (R.M.).
authors: Paul
authors: P
authors: Frank
authors: From the UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at University of California, Los Angeles (P.B., E.B., P.F., M.S., R.T., K.S., R.M.); and International Heart Institute, Loma Linda University Medical Center, CA (R.M.).
authors: Michael
authors: M
authors: Share
authors: From the UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at University of California, Los Angeles (P.B., E.B., P.F., M.S., R.T., K.S., R.M.); and International Heart Institute, Loma Linda University Medical Center, CA (R.M.).
authors: Roderick
authors: R
authors: Tung
authors: From the UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at University of California, Los Angeles (P.B., E.B., P.F., M.S., R.T., K.S., R.M.); and International Heart Institute, Loma Linda University Medical Center, CA (R.M.).
authors: Kalyanam
authors: K
authors: Shivkumar
authors: From the UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at University of California, Los Angeles (P.B., E.B., P.F., M.S., R.T., K.S., R.M.); and International Heart Institute, Loma Linda University Medical Center, CA (R.M.).
authors: Ravi
authors: R
authors: Mandapati
mesh_terms: D000046:Academic Medical Centers; D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D017115:Catheter Ablation; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: atrial fibrillation; catheter ablation; electrophysiology