title: Treatment of Recurrent Nonparoxysmal Atrial Fibrillation Using Focal Impulse and Rotor Mapping (FIRM)-Guided Rotor Ablation: Early Recurrence and Long-Term Outcomes.
abstract: A patient-tailored ablation approach focused on the elimination of both pulmonary vein triggers as well as substrate drivers may result in favorable outcomes in recurrent persistent AF patients.
  
  
  
  We evaluated the long-term outcomes of rotor ablation combined with conventional pulmonary vein isolation (PVI) in patients with recurrent nonparoxysmal AF.
  
  
  
  Fifty-eight consecutive patients underwent FIRM-guided rotor ablation followed by conventional PVI for the treatment of recurrent nonparoxysmal AF. A software algorithm was used to display rotational activity at rotor sites by creating propagation maps from unipolar electrograms recorded using a 64-electrode basket catheter. These rotor sites were targeted for ablation, followed by conventional PVI.
  
  
  
  All patients had nonparoxysmal AF (83% longstanding persistent) and a previously failed conventional ablation procedure. Stable rotors were identified in all patients (mean of 3.0 ± 1.6 per patient), with 55.2% having right atrial rotors and 96.6% left atrial rotors, respectively. Complications occurred in 5.2% of patients, none related to the FIRM procedure. The median follow-up was 12 months. At 6 and 12 months of follow-up, 73.2% and 76.9% of patients remained free from AF/AT, respectively. Excluding 2 patients who underwent a successful redo ablation procedure/electrical cardioversion, at 12 months of follow-up, 69.2% were free from any AF/AT and 73.1% were free from AF after a single FIRM-guided ablation procedure.
  
  
  
  A high degree of success was observed in this cohort of primarily longstanding persistent AF patients treated for recurrent AF with FIRM-guided rotor ablation. Prospective randomized controlled trials are needed.
authors.affiliation: Praxisklinik Herz und Gefäße Dresden, Akademische Lehrpraxisklinik der TU Dresden, Dresden, Germany.|Brandenburg University of Technology Cottbus-Senftenberg, Institute of Medical Technology, Germany.
authors.forename: Stefan Georg
authors.initials: SG
authors.lastname: Spitzer
authors.affiliation: Praxisklinik Herz und Gefäße Dresden, Akademische Lehrpraxisklinik der TU Dresden, Dresden, Germany.
authors.forename: László
authors.initials: L
authors.lastname: Károlyi
authors.affiliation: Praxisklinik Herz und Gefäße Dresden, Akademische Lehrpraxisklinik der TU Dresden, Dresden, Germany.
authors.forename: Carola
authors.initials: C
authors.lastname: Rämmler
authors.affiliation: Praxisklinik Herz und Gefäße Dresden, Akademische Lehrpraxisklinik der TU Dresden, Dresden, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Scharfe
authors.affiliation: Praxisklinik Herz und Gefäße Dresden, Akademische Lehrpraxisklinik der TU Dresden, Dresden, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Weinmann
authors.affiliation: Praxisklinik Herz und Gefäße Dresden, Akademische Lehrpraxisklinik der TU Dresden, Dresden, Germany.
authors.forename: Mirko
authors.initials: M
authors.lastname: Zieschank
authors.affiliation: Praxisklinik Herz und Gefäße Dresden, Akademische Lehrpraxisklinik der TU Dresden, Dresden, Germany.
authors.forename: Anke
authors.initials: A
authors.lastname: Langbein
mesh_terms: D000200:Action Potentials; D000368:Aged; D000465:Algorithms; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors; D012815:Signal Processing, Computer-Assisted; D012984:Software; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
keywords: FIRM; atrial fibrillation; catheter ablation; rotor; spiral wave