Trial reportEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2023
Randomized evaluation of redo ablation procedures of atrial fibrillation with focal impulse and rotor modulation-guided procedures: the REDO-FIRM study.
Trial report in 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, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
What it found
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The trial behind it
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Who cites it
20 citing papers in PubMed.
- Catheter Ablation for Persistent Atrial Fibrillation: Rationale, Evidence, and Contemporary Strategies Beyond Pulmonary Veins.Journal of clinical medicine · 2026Review
- Auto reference vector: a novel method for mapping atrial fibrillation.Frontiers in cardiovascular medicine · 2026Article
- Clinical Burden of Post-ablation Atrial Fibrillation Recurrence in East Asia: A Systematic Literature Review.Arrhythmia & electrophysiology review · 2026Review
- Outcomes after redo ablation for the recurrence of atrial fibrillation: a systematic review and meta-analysis.Clinical research in cardiology : official journal of the German Cardiac Society · 2025Article
- Prospective evaluation of low voltage-guided repeat ablation of atrial fibrillation.Clinical research in cardiology : official journal of the German Cardiac Society · 2025Article
- 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
- Digital twins enable stratification of persistent atrial fibrillation patients for ablation diminishing unnecessary heart damage.NPJ digital medicine · 2025Article
- TAILORing AI-guided treatment for atrial fibrillation.Nature medicine · 2025Article
- Strategies for Recurrent Atrial Fibrillation in Patients Despite Durable Pulmonary Vein Isolation.Journal of clinical medicine · 2025Article
- "Pharmacological" analysis of atrial fibrillation maintenance mechanism: reentry, wavelets, or focal?Frontiers in cardiovascular medicine · 2025Review
- Catheter Ablation in Atrial Fibrillation: Recent Advances.Journal of clinical medicine · 2024Review
- Ablation Strategies for Persistent Atrial Fibrillation: Beyond the Pulmonary Veins.Journal of clinical medicine · 2024Review
- Mid-to-long-term recurrence of atrial fibrillation in surgical treatmentAnnals of cardiothoracic surgery · 2024Article
- Mapping Atrial Fibrillation Drivers.Reviews in cardiovascular medicine · 2024Review
- Dipole Density Guided Catheter Ablation versus Conventional Substrate Modification for Repeat Catheter Ablation of Persistent Atrial Fibrillation.Journal of clinical medicine · 2023Article
- Electrographic flow mapping of persistent atrial fibrillation: intra- and inter-procedure reproducibility in the absence of 'ground truth'.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 · 2023Article
- Progress in atrial fibrillation ablation during 25 years of Europace journal.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 · 2023Article
- Treatment of pathophysiologic propagation outside of the pulmonary veins in retreatment of atrial fibrillation patients: RECOVER AF study.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 · 2023Article
- Mapping for nonpulmonary vein atrial fibrillation sources: The road to improved ablation outcomes.Journal of cardiovascular electrophysiology · 2023Article
- Comparison of clinical outcomes of Ibutilide-guided cardioversion and direct current synchronized cardioversion after radiofrequency ablation of persistent atrial fibrillation.Frontiers in cardiovascular medicine · 2023Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
aimsREDO-FIRM evaluated safety and effectiveness of conventional vs. focal impulse and rotor modulation (FIRM)-guided ablation of recurrent persistent or paroxysmal atrial fibrillation (AF) after an initial AF ablation procedure. METHODS AND
resultsThis prospective, multicentre, randomized study included patients with a single prior AF ablation, but with recurrent AF and reconnected pulmonary veins (PVs). Conventional ablation generally included PV re-isolation; however, additional ablation was permitted per physician discretion. In the FIRM arm, beyond PV re-isolation, basket catheter-based FIRM mapping created dynamic animations of putative rotors, which were targeted for ablation. Between May 2016 and July 2019, 269 subjects were randomized, with 243 subjects completing 12-month follow-up. Ablation beyond re-pulmonary vein isolation, the FIRM vs. Conventional arms did not differ significantly: cavo-tricuspid isthmus -9.0% vs. 15.3%, caval vein isolation -1.5% vs. 0.8%, non-PV trigger -2.2% vs. 3.8%, other -11.9% vs. 13.0%. Single procedure 12-month freedom from AF/atrial tachycardia/atrial flutter-recurrence was 63.3% (76/120) vs. 59.0% (72/122) in the FIRM and Conventional arms (P = 0.3503). Efficacy was similar in the paroxysmal and persistent AF subgroups (P = 0.22 and P = 0.48). The 10-day and 12-month safety endpoints were achieved in 93.3% vs. 93.8% (P = 0.89) and 88.4% vs. 93.4% (P = 0.22) in the FIRM and Conventional arms, respectively.
conclusionsIn REDO-FIRM, as compared to standard ablation, FIRM-guided ablation did not provide additional efficacy in redo ablation procedures, but FIRM-guided ablation was equally safe. Additional studies are necessary to identify any potential population able to benefit from FIRM-guided ablation.
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