Focal Ablation of Atrial Fibrillation: The Target Remains Elusive

Antonis S Manolis


Contemporary technology using mapping tools and algorithms in animal and computer models has suggested discrete atrial fibrillation (AF)-sustaining mechanisms in the form of electric rotors as focal areas of AF perpetuation. When these focal sites were targeted, ablation initially appeared promising in reducing the recurrence rates of AF. However, many other investigators have been unable to reproduce this kind of success with focal impulse and rotor modulation (FIRM)-guided ablation, and have cast doubts on the effectiveness of this novel technique that could have led to a paradigm-shift in our approach to AF ablation. A single randomized trial that was recently published in a high-impact cardiology journal indicating poor results of rotor ablation was subsequently retracted amidst a cloud of controversy and doubt about the flaws and conflicts of current medical publishing. Thus, until further evidence from ongoing and future randomized studies becomes available, the target of focal ablation for AF patients continues to remain elusive. Rhythmos 2017;12(2):21-25.


atrial fibrillation; acute atrial fibrillation; persistent atrial fibrillation; catheter ablation; rotors; focal impulses; focal fibrillation waves; pulmonary vein isolation

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