Results from the CONFIRM trial (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation) published July 18 in the Journal of the American College of Cardiology “demonstrate for the first time that human atrial fibrillation (AF) may be sustained by localized sources in the form of electrical rotors and focal impulses.”

Catheter ablation has shown to be more effective than medication for treating AF; however, “silent” AF often occurs in patients post ablation which leads to “multiple lengthy and costly procedures that confer at least modest risk” for many patients. Given that “current tools may not create durable lesions” and “mechanisms that sustain AF are not identified,” contemporary AF ablation is often limited.

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Researchers from the University of California San Diego, the University of California Los Angeles (UCLA) and Indiana University developed a computational approach to map “whether AF is sustained by several meandering waves (the prevailing hypothesis) or localized sources, then prospectively tested whether targeting patient-specific mechanisms revealed by mapping would improve AF ablation outcome.” The study examined 107 consecutive ablation procedures in 92 patients.
 
Results showed that focal impulse and rotor modulation (FIRM) ablation to eliminate the few localized sources that cause AFF was able to abruptly end or consistently slow persistent and paroxysmal AF in the vast majority of cases. In addition, FIRM was able to substantially improve long-term AF elimination over conventional ablation alone. “FIRM mapping may open the possibility for several patient-tailored therapies for AF in addition to ablation for this highly prevalent disease with major public health and societal impact,” the authors noted. 

According to a statement from UCLA, the new findings will help cardiologists better target and treat arrhythmias. “This is the dawn of a new phase of managing this common arrhythmia that is mechanism-based,” said Kalyanam Shivkumar, MD, PhD, an author in the study.

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