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Rotor Locations and 1 Year Outcomes of FIRM AblationIntroduction 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. Methods and 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. Conclusion 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.

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.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.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.

Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide and is associated with significant morbidity and mortality. Its prevalence increases with increasing age, and is one of the leading causes of thromboembolism, including ischemic stroke. The prevalence of cognitive dysfunction also increases with increasing age. Although several studies have shown a strong correlation between AF and cognitive dysfunction in patients with and without overt stroke, a direct causative link has yet to be established. Rhythm vs rate control and anticoagulation regimens have been extensively investigated, particularly with the introduction of the novel anticoagulants. With catheter ablation becoming more prevalent for the management of AF and the ongoing development of various new energy sources and catheters, an additional thromboembolism risk is introduced. As cognitive dysfunction decreases the patient’s ability to self-care and manage a complex disease such as AF, this increases the burden to our healthcare system. Therefore as the prevalence of AF increases in the general population, it becomes more imperative that we strive to optimize our methods to preserve cognitive function. This review gives an overview of the current evidence behind the association of AF with cognitive dysfunction, and discusses the most up-to-date medical and procedural treatment strategies available for decreasing thromboembolism associated with AF and its treatment, which may lead to preserving cognitive function.