Related Experiment Video
Updated: Jun 11, 2026
28:13
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
33.5K
Prospective Randomized Trial of Rotor Ablation vs Conventional Ablation for Persistent Atrial Fibrillation: REAFFIRM
Johannes Brachmann1, Thomas Vogtmann2, John Hummel3
1Klinikum Coburg Sana Medical School, University of Split School of Medicine Coburg Germany.
Journal of the American Heart Association
|June 18, 2025
Summary
Adding Focal Impulse and Rotor Modulation (FIRM) ablation to conventional pulmonary vein isolation (PVI) did not improve outcomes for persistent atrial fibrillation patients in a large trial. The study found no significant difference in effectiveness or safety between the two approaches.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Pulmonary vein isolation (PVI) is a primary treatment for symptomatic drug-refractory atrial fibrillation but has limited curative rates.
- Focal and rotational drivers are implicated in atrial fibrillation mechanisms, yet their ablation yields variable results.
- The REAFFIRM trial investigated the efficacy of adding Focal Impulse and Rotor Modulated (FIRM) ablation to conventional PVI.
Purpose of the Study:
- To compare the safety and effectiveness of conventional ablation versus FIRM-guided ablation using global basket mapping for persistent atrial fibrillation.
- To evaluate if FIRM ablation improves outcomes compared to standard PVI in patients with persistent atrial fibrillation.
Main Methods:
- A randomized trial involving 375 patients across 18 centers, with 350 in the Intent-to-Treat (ITT) population.
- Primary effectiveness endpoint: freedom from atrial fibrillation/atrial tachycardia recurrence at 3 to 12 months post-procedure.
- Patients were randomized to conventional PVI or PVI with FIRM-guided ablation.
Main Results:
- No significant difference in primary effectiveness between FIRM and conventional arms (69.3% vs. 67.5%, respectively).
- No differences observed in ablation procedure time or safety profiles.
- On-treatment analysis showed varied effectiveness based on additional ablation strategies, but overall ITT analysis was not statistically significant.
Conclusions:
- The addition of FIRM ablation to conventional PVI did not demonstrate superiority in treating persistent atrial fibrillation based on intention-to-treat analysis.
- Further research may be needed to identify patient subgroups who could benefit from FIRM-guided ablation.
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