Focal Impulse and Rotor Modulation (FIRM) mapping effectively targets atrial fibrillation (AF) sources and improves ablation therapy outcomes

Media Contact

Kennesha Baldwin
Heart Rhythm Society

DENVER– New research presented at Heart Rhythm 2013, the Heart Rhythm Society’s 34th Annual Scientific Sessions, continues to show promising results for Focal Impulse and Rotor Modulation (FIRM) guided ablation in patients with atrial fibrillation (AF). The novel diagnostic real-time mapping system helps target ablation therapy to patient-specific drivers of AF rather than to anatomical targets, which can improve patient outcomes. View the study abstract.

More than 2 million people in the United States have AF, a common heart rhythm disorder which causes an irregular and rapid heartbeat. Although it isn’t life threatening, AF can lead to other problems including chronic fatigue, congestive heart failure and stroke.

“This new procedure has the potential to dramatically change how we treat patients with atrial fibrillation,” said Vijay Swarup, MD, FHRS, director of Cardiac Electrophysiology at Arizona Heart Hospital. “New findings help us better understand that small electrical spinning tops – rotors – or focal sources drive AF, the stability of these sources and exactly where to treat them.”

New research builds on the CONFIRM trial findings from 2011 that first showed AF was acutely terminated or substantially slowed with less than 10 minutes of FIRM-guided ablation per identified source.

A new study, led by Robert Kowal, MD, and presented today at Heart Rhythm 2013, provides more information on how FIRM-guided ablation effectively treats AF. FIRM mapping was performed in 210 patients at 11 U.S. centers.  Ablation was targeted prospectively at rotors or focal sources in 132 consecutive patients, of whom 25 percent had paroxysmal AF and 75 percent had persistent AF. FIRM-guided ablation achieved an acute endpoint in 82.9 percent of patients with ten minutes of total ablation.  This included terminating AF and rendering it non-inducible in 55.8 percent of patients, in whom the majority (69 percent) terminated to sinus rhythm and 31 percent terminated to atrial tachycardia.

A second study, led by Vijay Swarup, MD, also presented today at Heart Rhythm 2013, used FIRM to MAP where electrical rotors or focal sources are located in the heart and found that sources exist in diverse stable locations throughout the atria. The 11-multicenter prospective trial mapped AF in 210 consecutive patients, of whom 132 had FIRM-guided ablation at rotor or focal sources of AF. Sources were revealed in 99.2 percent of patients, and more than half of the AF sources were located away from pulmonary veins. These results further confirm the importance of mapping AF sources in each patient compared to traditional pulmonary vein isolation therapy. In FIRM guided patients, AF termination or 10 percent slowing was achieved in 82.9 percent of cases.

Session details:
“Localized Focal Impulse and Rotor Modulation (FIRM) Terminates AF into Micro-Reentry, Residual Atrial Tachycardia or Sinus Rhythm: A Unifying Mechanistic Hypothesis” [Friday, May 10, 2013, 1:30 p.m. – 3:00 p.m. MDT, Bellco Theatre 1]

“Stable Atrial Fibrillation Rotors and Focal Sources Lie in Diverse Bi-Atrial Locations Often Remote from the Pulmonary Veins” [Friday, May 10, 2013, 1:30 p.m. – 3:00 p.m. MDT, Bellco Theatre 2]

Heart Rhythm 2013 is the most comprehensive educational program for heart rhythm professionals, featuring more than 8,000 attendees, 250 educational sections and more than 130 exhibitors showcasing innovative products and services.  The Heart Rhythm Society’s Annual Scientific Sessions have become the must-attend event of the year, allowing the exchange of new vital ideas and information among colleagues from every corner of the globe.

About the Heart Rhythm Society

The Heart Rhythm Society is the international leader in science, education and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education and optimal health care policies and standards. Incorporated in 1979 and based in Washington, DC, it has a membership of more than 5,800 heart rhythm professionals in more than 72 countries around the world. For more information, visit, voted 2012’s “Best in Class” website for a nonprofit by the Interactive Media Council.

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