Mapping and ablation of electrical rotor and focal sources for atrial fibrillation: a patient‐tailored mechanistic approach

• Published in: Practical Guide to Catheter Ablation of Atrial Fibrillation pp. 271 - 282
• Main Authors: Zaman, Junaid A. B, Mulpuru, Siva K, Krummen, David E, Narayan, Sanjiv M
• Format: Book Chapter
• Language: English
• Published: Chichester, UK John Wiley & Sons Ltd 14.12.2015
• Subjects: atrial fibrillation; electrical rotors; electrogram; FIRM ablation; FIRM mapping
• ISBN: 9781118658505; 1118658507
• DOI: 10.1002/9781118658369.ch18

This chapter illustrates electrical rotors in human atrial fibrillation (AF) and differences from atrial flutter on focal impulse and rotor mapping (FIRM) mapping. It displays the clinical characteristics of the patient group. Persistent AF was present in 81% of the FIRM‐guided group, and in 66% of the FIRM‐blinded group.It presents the nomenclature of FIRM maps, in which the left atrium is opened at its “equator” and the right atrium is opened along a meridian. Mapping analyzes contact electrograms, which are the reference standard for signal fidelity, using recently reported human rate‐response properties of atrial repolarization and regional conduction. In FIRM‐guided subjects, ablation commenced with the elimination of AF rotors or focal sources using various radiofrequency sources. CONFIRM and recent confirmatory multicenter studies of FIRM were not randomized, although subjects were enrolled and treated prospectively for prespecified end points.