Herzschrittmachertherapie + Elektrophysiologie

, Volume 29, Issue 3, pp 315–321 | Cite as

Rotor mapping: black box or very simple? The FIRM approach

  • Stefan Georg Spitzer
  • László Károlyi
  • Carola Rämmler
  • Frank Scharfe
  • Mirko Zieschank
  • Anke Langbein


Catheter ablation has become the most common therapy in patients with atrial fibrillation (AF). However, despite significant advances in technology and operators’ experience, ablation outcomes remain suboptimal, especially in patients with persistent AF. Focal impulse and rotor modulation (FIRM) represents a new technology for mapping and ablation of patient-specific AF sources. This approach is based on the concept of localized sources, which can be understood as organized rotational waves or focal impulses driving disorganized AF. Several studies, mainly single-center case series, have shown an incremental benefit in long-term outcome when adding FIRM-guided ablation to conventional pulmonary vein isolation (PVI). Therefore, the results of ongoing multicenter randomized trials are needed to support this data.


Atrial fibrillation Catheter ablation Rotors Focal impulses Pulmonary vein isolation 

Rotormapping: Blackbox oder ganz einfach? Das FIRM-Konzept


Die Katheterablation hat sich als Standardtherapie für Patienten mit Vorhofflimmern etabliert. Trotz signifikanter technologischer Fortschritte und zunehmender Untersuchererfahrung sind die Ablationsergebnisse aber noch nicht zufriedenstellend. Dies gilt insbesondere für Patienten mit persistierendem Vorhofflimmern. Die „focal impulse and rotor modulation“ (FIRM) ist eine neue Technologie für das Mapping und Abladieren von patientenindividuellen Quellen von Vorhofflimmern. Sie beruht auf dem Konzept, dass Vorhofflimmern durch organisierte Rotoren und fokale Impulse ausgelöst und unterhalten werden kann. Verschiedene Studien – die meisten monozentrische Fallserien – haben bezüglich des Langzeitergebnisses einen Vorteil der FIRM-gestützten Ablation gegenüber der alleinigen Pulmonalvenenisolation aufgezeigt. Die Ergebnisse laufender randomisierter Multicenterstudien werden daher mit großem Interesse erwartet.


Vorhofflimmern Katheterablation Rotoren Fokale Impulse Pulmonalvenenisolation 


Compliance with ethical guidelines

Conflict of interest

S.G. Spitzer received speaking fees and travel support from Medtronic, St. Jude Medical, Abbott and Topera and participated in clinical trials for Abbott and Medtronic. L. Karolyi received speaking fees from Abbott and participated in clinical trials for Abbott and Medtronic. A. Langbein received speaking fees and travel support from Medtronic, Abbott and Boston and participated in clinical trials for Abbott and Medtronic. C. Rämmler, F. Scharfe, and M. Zieschank declare that they have no competing interests.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • Stefan Georg Spitzer
    • 1
    • 2
  • László Károlyi
    • 1
  • Carola Rämmler
    • 1
  • Frank Scharfe
    • 1
  • Mirko Zieschank
    • 1
  • Anke Langbein
    • 1
  1. 1.Praxisklinik Herz und Gefäße DresdenAkademische Lehrpraxisklinik der TU DresdenDresdenGermany
  2. 2.Institute of Medical TechnologyBrandenburg University of Technology Cottbus-SenftenbergSenftenbergGermany

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