title: Focal Impulse and Rotor Modulation for the Treatment of Atrial Fibrillation: Locations and 1 Year Outcomes of Human Rotors Identified Using a 64-Electrode Basket Catheter.
abstract: BACKGROUND
  Pulmonary vein isolation (PVI) is currently the gold standard for catheter ablation of atrial fibrillation (AF). The mechanism for AF-maintenance is still controversial. The concept of rapidly activating spiral rotors perpetuating AF has led to the development of several rotor-mapping systems. We present our experience with focal impulse and rotor modulation (FIRM) using a 64-electrode basket catheter and computational system and evaluate its feasibility in conjunction with PVI to treat AF.
  
  
  RESULTS
  Twenty-five patients underwent FIRM mapping and ablation to treat AF (paroxysmal = 10, 40%). A basket catheter was used for rotor identification within the right atrium (RA) then left atrium (LA). Radiofrequency energy was applied at and around each rotor core for 300 seconds and rotor-mapping and ablation was repeated until all rotors were eliminated before circumferential PVI was performed. Three (1.0, 4.0) rotors were identified per patient, predominantly in the LA (LA = 59). Note that 7/59 left-sided rotors were located 8/59 at the PV antrum. Twelve (48%) patients had either AF termination (termination = 6/12) or conversion to another rhythm, or cycle length (CL) prolongation ≥10% after rotor ablation. After a single procedure, 13 (52%) patients were free of atrial tachyarrhythmia after a follow-up period of 13 ± 1 months.
  
  
  CONCLUSIONS
  Early results suggest that FIRM-ablation can terminate AF in a significant number of patients. Rotors were frequently identified in the PVs and PV antrum, supporting PVI as the cornerstone of AF ablation.
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Roland Richard
authors.initials: RR
authors.lastname: Tilz
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Tina
authors.initials: T
authors.lastname: Lin
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Rillig
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Christian-H
authors.initials: CH
authors.lastname: Heeger
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Leonie
authors.initials: L
authors.lastname: Scholz
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Wohlmuth
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Tudor
authors.initials: T
authors.lastname: Bucur
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Metzner
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Shibu
authors.initials: S
authors.lastname: Mathew
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Erik
authors.initials: E
authors.lastname: Wissner
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Feifan
authors.initials: F
authors.lastname: Ouyang
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
mesh_terms: D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation*; D018572:Disease-Free Survival; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac / Q000295:instrumentation*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: FIRM mapping; atrial fibrillation; catheter ablation; novel technologies; pulmonary vein isolation