A Focal Impulse and Rotor Mapping (FIRM) Ablation Approach for Recurrent Persistent Atrial Fibrillation

Focal impulse and Rotor Modulation (FIRM) has been introduced recently as a new approach for ablation of atrial fibrillation (AF). We report a case of FIRM-guided rotor ablation, performed in combination with (re)-pulmonary vein isolation in a patient with recurrent persistent AF and two previous failed conventional ablation procedures. Four rotors could be detected and successfully ablated in this patient, one in the right atrium and three in the left atrium. Notably, the patient experienced a short-term recurrence of AF with spontaneous conversion back to sinus rhythm 11 weeks after the procedure. However, now the patient has been in stable sinus rhythm for 19 months. This case highlights the need to effectively address the specific AF mechanisms, especially in patients with recurrent persistent atrial fibrillation. FIRM-guided rotor ablation seems to be a beneficial option for these patients.