Randomized evaluation of redo ablation procedures of atrial fibrillation with focal impulse and rotor modulation-guided procedures: the REDO-FIRM study. Issue 1 (3rd September 2022)

• Record Type: Journal Article
• Authors: Spitzer, Stefan G; Miller, John M; Sommer, Philipp; Szili-Torok, Tamas; Reddy, Vivek Y; Nölker, Georg; Williams, Chris; Sarver, Anne; Wilber, David J
• Is Part Of: Europace. Volume 25:Issue 1(2023)
• Page Start: 74
• Page End: 82
• Publication Date: 2022-09-03
• Subjects: Recurrent AF -- Rotor -- Focal Impulse and Rotor Modulation; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euac122
• Languages: English
• ISSNs: 1099-5129

Abstract

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.