Abstract
Historically, pulmonary veins have been the focus of atrial fibrillation (AF) ablation therapy, but it is increasingly being recognized that localized electric rotors and focal impulse sources have a role in maintaining AF. Targeting of these sources using focal impulse and rotor modulation (FIRM)-guided ablation has resulted in elimination of the source and improved long-term outcomes. FIRM uses wide-area mapping of both atria in AF, using commercially-available basket catheters (to provide contact electrograms). However, not all data support the use of FIRM. This paper provides a description of rotor mapping and ablation. In addition, practical strategies for optimizing the technique are discussed, including: catheter positioning; accurate diagnosis of the presence and locations of focal sources; and amount of ablation performed in regions with rotors or foci.
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