Rotor and Focal Source Mapping and Ablation in Atrial Fibrillation

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Most electrophysiologists who perform catheter ablation procedures for treatment of atrial fibrillation (AF) believe rotors have a role in maintaining AF, but it is not clear how much of a role or in what proportion of cases. Recent literature has shown varying outcomes using focal impulse and rotor modulation (FIRM)-guided ablation. Some of the factors potentially responsible for these inconsistent results include variability among operators in: rigor of basket catheter positioning; confidence in diagnosing the presence and locations of focal sources; and amount of ablation performed in regions designated as having rotors or foci. In this webinar, we will: give some background of the basis of rotor-guided ablation of AF; set forth different workflows used during procedures; and attempt to address some of the current controversies in rotor mapping and ablation.


John M Miller

John M Miller

This webinar is supported by

Key Learning Objectives

  • Tips in recognizing rotor activity on complex maps
  • Streamlining workflows during rotor mapping and ablation
  • Determining intra-procedural endpoints of rotor ablation
  • Why results of rotor mapping-guided ablation may differ among groups

Target Audience

  • Cardiac electrophysiologists who perform catheter ablation in persistent AF patients

Faculty Biographies

John M Miller

John M Miller

John M. Miller, MD is a professor of Medicine and head of the Electrophysiology Service at Indiana University School of Medicine, has been active in research into mechanisms of arrhythmias and development of new mapping and ablation techniques for many years, including those pertaining to atrial fibrillation (AF). He was involved in some of the early work with Dr. Sanjiv Narayan in mapping of rotors in human AF. He has extensive experience with rotor and focus-guided mapping and ablation and has recently authored the largest series in the literature to date on outcomes of AF ablation using focal impulse and rotor modulation (FIRM).

Dr Miller is a fellow of the American College of Cardiology and Heart Rhythm Society. He is certified by the American Board of Internal Medicine (ABIM) in Internal Medicine, Cardiovascular Diseases and Clinical Cardiac Electrophysiology. He has served on the ABIM’s certification examination writing committee and was its chairman for 4 years, and now serves on the ABIM’s Self Examination Process in Clinical Cardiac Electrophysiology. He has been awarded the Indiana University Trustee Teaching Award twice as well as the Heart Rhythm Society’s Distinguished Teacher Award.

Dr Miller is on the AER editorial board.

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Key References

1. Narayan SM, Krummen DE, Shivkumar K, Clopton P, Rappel W-J, Miller J. Treatment of atrial fibrillation by the ablation of localized sources: the conventional ablation for atrial fibrillation with or without focal impulse and rotor modulation: CONFIRM trial. J Am Coll Cardiol 2012;60:628-636.

2. Miller JM, Kowal RC, Swarup V et al. Initial independent outcomes from focal impulse and rotor modulation ablation for atrial fibrillation: multicenter FIRM registry. J Cardiovasc Electrophysiol 2014;25:921-929.

3. Sommer P, Kircher S, Rolf S et al. Successful repeat catheter ablation of recurrent longstanding persistent atrial fibrillation with rotor elimination as the procedural endpoint: a case series. J Cardiovasc Electrophysiol 2016;27:274-280.