ReviewJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing2014
Mapping and ablating stable sources for atrial fibrillation: summary of the literature on Focal Impulse and Rotor Modulation (FIRM).
Review in Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
14 citing papers in PubMed, 23 citations in OpenAlex.
- Persistent atrial fibrillation ablation: glimpsing the light ahead?Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Review
- Dipole Density Guided Catheter Ablation versus Conventional Substrate Modification for Repeat Catheter Ablation of Persistent Atrial Fibrillation.Journal of clinical medicine · 2023Article
- High-density mapping of the average complex interval helps localizing atrial fibrillation drivers and predicts catheter ablation outcomes.Frontiers in cardiovascular medicine · 2023Article
- Surgery and Catheter Ablation for Atrial Fibrillation: History, Current Practice, and Future Directions.Journal of clinical medicine · 2021Review
- Atrial fibrillation source area probability mapping using electrogram patterns of multipole catheters.Biomedical engineering online · 2020Article
- Repeat pulmonary vein isolation with or without FIRM-guided ablation for recurrent atrial fibrillation with pulmonary vein reconnection.Journal of cardiovascular electrophysiology · 2020Article
- Challenges Associated with Interpreting Mechanisms of AF.Arrhythmia & electrophysiology review · 2020Review
- Linking Electrical Drivers With Atrial Cardiomyopathy for the Targeted Treatment of Atrial Fibrillation.Frontiers in physiology · 2020Review
- Cryoballoon ablation results and complications in mid-term follow-up of patients with atrial fibrillation.ARYA atherosclerosis · 2018Article
- Rotor mapping: black box or very simple? The FIRM approach.Herzschrittmachertherapie & Elektrophysiologie · 2018Review
- Ten-year outcome of intraoperative treatment of atrial fibrillation using radiofrequency ablation.Therapeutics and clinical risk management · 2017Article
- Cryoablation in persistent atrial fibrillation - a critical appraisal.Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2016Review
- QUest for the Arrhythmogenic Substrate of Atrial fibRillation in Patients Undergoing Cardiac Surgery (QUASAR Study): Rationale and Design.Journal of cardiovascular translational research · 2016Article
- Deciphering the fundamental mechanisms of atrial fibrillation: a quest for over a century.Cardiovascular research · 2016Article
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.