Randomized evaluation of redo ablation procedures of atrial fibrillation with focal impulse and rotor modulation-guided procedures: the REDO-FIRM study
dc.contributor.author | Spitzer, Stefan G. | |
dc.contributor.author | Miller, John M. | |
dc.contributor.author | Sommer, Philipp | |
dc.contributor.author | Szili-Torok, Tamas | |
dc.contributor.author | Reddy, Vivek Y. | |
dc.contributor.author | Nölker, Georg | |
dc.contributor.author | Williams, Chris | |
dc.contributor.author | Sarver, Anne | |
dc.contributor.author | Wilber, David J. | |
dc.contributor.department | Medicine, School of Medicine | |
dc.date.accessioned | 2023-12-04T14:05:59Z | |
dc.date.available | 2023-12-04T14:05:59Z | |
dc.date.issued | 2023 | |
dc.description.abstract | Aims: REDO-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 results: This 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. Conclusions: In 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. | |
dc.eprint.version | Final published version | |
dc.identifier.citation | Spitzer SG, Miller JM, Sommer P, et al. Randomized evaluation of redo ablation procedures of atrial fibrillation with focal impulse and rotor modulation-guided procedures: the REDO-FIRM study. Europace. 2023;25(1):74-82. doi:10.1093/europace/euac122 | |
dc.identifier.uri | https://hdl.handle.net/1805/37274 | |
dc.language.iso | en_US | |
dc.publisher | Oxford University Press | |
dc.relation.isversionof | 10.1093/europace/euac122 | |
dc.relation.journal | Europace | |
dc.rights | Attribution 4.0 International | en |
dc.rights.uri | http://creativecommons.org/licenses/by/4.0/ | |
dc.source | PMC | |
dc.subject | Focal impulse | |
dc.subject | Rotor modulation | |
dc.subject | Recurrent AF | |
dc.subject | Rotor | |
dc.title | Randomized evaluation of redo ablation procedures of atrial fibrillation with focal impulse and rotor modulation-guided procedures: the REDO-FIRM study | |
dc.type | Article |