| Title |
Mapping and ablating stable sources for atrial fibrillation: summary of the literature on Focal Impulse and Rotor Modulation (FIRM)
|
|---|---|
| Published in |
Journal of Interventional Cardiac Electrophysiology, March 2014
|
| DOI | 10.1007/s10840-014-9889-8 |
| Pubmed ID | |
| Authors |
Tina Baykaner, Gautam G. Lalani, Amir Schricker, David E. Krummen, Sanjiv M. Narayan |
| Abstract |
Atrial fibrillation (AF) is the most common sustained arrhythmia and the most common indication for catheter ablation. However, despite substantial technical advances in mapping and energy delivery, ablation outcomes remain suboptimal. A major limitation to AF ablation is that the areas targeted for ablation are rarely of proven mechanistic importance, in sharp contrast to other arrhythmias in which ablation targets demonstrated mechanisms in each patient. Focal impulse and rotor modulation (FIRM) is a new approach to demonstrate the mechanisms that sustain AF ("substrates") in each patient that can be used to guide ablation then confirm elimination of each mechanism. FIRM mapping reveals that AF is sustained by 2-3 rotors and focal sources, with a greater number in patients with persistent than paroxysmal AF, lying within spatially reproducible 2.2 ± 1.4-cm(2) areas in diverse locations. This temporospatial reproducibility, now confirmed by several groups using various methods, changes the concepts regarding AF-sustaining mechanisms, enabling localized rather than widespread ablation. Mechanistically, the role of rotors and focal sources in sustaining AF has been demonstrated by the acute and chronic success of source (FIRM) ablation alone. Clinically, adding FIRM to conventional ablation substantially improves arrhythmia freedom compared with conventional ablation alone, and ongoing randomized trials are comparing FIRM-ablation with and without conventional ablation to conventional ablation alone. In conclusion, ablation of patient-specific AF-sustaining mechanisms (substrates), as exemplified by FIRM, may be central to substantially improving AF ablation outcomes. |
X Demographics
The data shown below were collected from the profiles of 5 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 3 | 60% |
| Ireland | 1 | 20% |
| Unknown | 1 | 20% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 4 | 80% |
| Science communicators (journalists, bloggers, editors) | 1 | 20% |
Mendeley readers
The data shown below were compiled from readership statistics for 37 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 1 | 3% |
| Netherlands | 1 | 3% |
| United States | 1 | 3% |
| Greece | 1 | 3% |
| Unknown | 33 | 89% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Ph. D. Student | 12 | 32% |
| Researcher | 9 | 24% |
| Student > Doctoral Student | 4 | 11% |
| Student > Postgraduate | 3 | 8% |
| Student > Master | 3 | 8% |
| Other | 4 | 11% |
| Unknown | 2 | 5% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 17 | 46% |
| Engineering | 13 | 35% |
| Computer Science | 1 | 3% |
| Unspecified | 1 | 3% |
| Unknown | 5 | 14% |