Focal impulse and rotor modulation as a stand-alone procedure for the treatment of paroxysmal atrial fibrillation: A within-patient controlled study with implanted cardiac monitoring

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…U pacjentów z udokumentowanym trzepotaniem zależnym od cieśni trójdzielno-żylnej, u których wykonuje się ablację AF, zaleca się ablację cieśni. Próby z zastosowaniem adenozyny w celu identyfikacji pacjentów wymagających dodatkowej ablacji pozostają kontrowersyjne po dokonaniu oceny tej metody w kilku doniesieniach [739,[742][743][744]. Ablacja tak zwanych rotorów, oparta na mapowaniu z powierzchni ciała lub mapowaniu wsierdziowym, jest przedmiotem oceny i obecnie nie można zalecać jej wykonywania w rutynowej praktyce klinicznej.…”

Maintenance of Atrial Fibrillation

“…However, two other studies 26 , including the recent OASIS trial 27 , show relatively poor outcomes for ablations relying on FIRM maps alone. The OASIS trial compared FIRM only ablation to FIRM plus pulmonary vein isolation (PVI) or PVI plus trigger elimination.…”

“…The OASIS trial compared FIRM only ablation to FIRM plus pulmonary vein isolation (PVI) or PVI plus trigger elimination. Of the three available studies that have investigated FIRM only ablation, two report 14% 27 and 22% 26 success rates in a total of 56 patients, while one study 28 in 31 patients reports 81% success. With contradicting results from FIRM only ablation, some attribute the lack of success as evidence against the presence of AF drivers; however, it may be due to the fact that FIRM did not identify all AF drivers, especially drivers at the ostium of a PV that are hidden by poor basket catheter contact with these regions.…”

Multicentre safety of adding Focal Impulse and Rotor Modulation (FIRM) to conventional ablation for atrial fibrillation

“…Debate continues on the benefit of basket mapping of human AF based on disappointing outcomes in small series from some centres. 18,20 However, even these studies show termination of AF to AT by FIRM-guided ablation alone in 34% of cases, 17 which strongly supports a mechanistic role of these sites. Moreover, FIRM-guided ablation has shown promising results in studies by Sommer et al, 4 Miller et al, 6 Tomassoni et al, 19 and Rashid et al 21 Additional data are required to determine the precise benefit of rotor and focal source mapping and ablation; randomized trials of FIRM þ PVI vs. PVI are currently underway.…”