title: Acute and early outcomes of focal impulse and rotor modulation (FIRM)-guided rotors-only ablation in patients with nonparoxysmal atrial fibrillation.
abstract: BACKGROUND
  Focal impulse and rotor modulation (FIRM)-guided ablation targets sites that are thought to sustain atrial fibrillation (AF).
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the acute and mid-term outcomes of FIRM-guided only ablation in patients with nonparoxysmal AF.
  
  
  METHODS
  We prospectively enrolled patients with persistent and long-standing persistent (LSP) AF at three centers to undergo FIRM-guided only ablation. We evaluated acute procedural success (defined as AF termination, organization, or ≥10% slowing), safety (incidence of periprocedural complications), and long-term success (single-procedure freedom from atrial tachycardia [AT]/AF off antiarrhythmic drugs [AAD] after a 2-month blanking period).
  
  
  RESULTS
  Twenty-nine patients with persistent (N = 20) and LSP (N = 9) AF underwent FIRM mapping. Rotors were presents in all patients, with a mean of 4 ± 1.2 per patient (62% were left atrial); 1 focal impulse was identified. All sources were successfully ablated, and overall acute success rate was 41% (0 AF termination, 2 AF slowing, 10 AF organization). There were no major procedure-related adverse events. After a mean 5.7 months of follow-up, single-procedure freedom from AT/AF without AADs was 17%.
  
  
  CONCLUSIONS
  In nonparoxysmal AF patients, targeted ablation of FIRM-identified rotors is not effective in obtaining AF termination, organization, or slowing during the procedure. After mid-term follow-up, the strategy of ablating FIRM-identified rotors alone did not prevent recurrence from AT/AF.
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David׳s Medical Center, Austin, Texas; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Carola
authors.initials: C
authors.lastname: Gianni
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David׳s Medical Center, Austin, Texas.
authors.forename: Sanghamitra
authors.initials: S
authors.lastname: Mohanty
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David׳s Medical Center, Austin, Texas; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York; Department of Biomedical Engineering, University of Texas, Austin, Texas; Department of Cardiology, Gülhane Military Academy of Medicine, Ankara, Turkey.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David׳s Medical Center, Austin, Texas.
authors.forename: Tamara
authors.initials: T
authors.lastname: Metz
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David׳s Medical Center, Austin, Texas.
authors.forename: Chintan
authors.initials: C
authors.lastname: Trivedi
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David׳s Medical Center, Austin, Texas; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.
authors.forename: Yalçın
authors.initials: Y
authors.lastname: Gökoğlan
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David׳s Medical Center, Austin, Texas.
authors.forename: Mahmut F
authors.initials: MF
authors.lastname: Güneş
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David׳s Medical Center, Austin, Texas.
authors.forename: Rong
authors.initials: R
authors.lastname: Bai
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David׳s Medical Center, Austin, Texas.
authors.forename: Amin
authors.initials: A
authors.lastname: Al-Ahmad
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David׳s Medical Center, Austin, Texas.
authors.forename: J David
authors.initials: JD
authors.lastname: Burkhardt
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David׳s Medical Center, Austin, Texas.
authors.forename: G Joseph
authors.initials: GJ
authors.lastname: Gallinghouse
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David׳s Medical Center, Austin, Texas; Department of Biomedical Engineering, University of Texas, Austin, Texas.
authors.forename: Rodney P
authors.initials: RP
authors.lastname: Horton
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David׳s Medical Center, Austin, Texas.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Hranitzky
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David׳s Medical Center, Austin, Texas.
authors.forename: Javier E
authors.initials: JE
authors.lastname: Sanchez
authors.affiliation: Clinic for Interventional Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt, Germany.
authors.forename: Phillipp
authors.initials: P
authors.lastname: Halbfaß
authors.affiliation: Clinic for Interventional Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt, Germany; University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Müller
authors.affiliation: Clinic for Interventional Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Schade
authors.affiliation: Clinic for Interventional Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt, Germany; University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Deneke
authors.affiliation: Baptist Health Lexington, Lexington, Kentucky.
authors.forename: Gery F
authors.initials: GF
authors.lastname: Tomassoni
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David׳s Medical Center, Austin, Texas; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York; Department of Biomedical Engineering, University of Texas, Austin, Texas; Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, California; MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio; Electrophysiology and Arrhythmia Services, California Pacific Medical Center, San Francisco, California,; Division of Cardiology, Stanford University, Stanford, California; Dell Medical School, University of Texas, Austin, Texas. Electronic address: dr.natale@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation / Q000295:instrumentation*; D004867:Equipment Design; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Atrial fibrillation; Catheter ablation; FIRM mapping; Rotor