Stand‐alone Focal Impulse and Rotor Modulation (FIRM) ablation versus second‐generation cryoballoon pulmonary vein isolation for paroxysmal atrial fibrillation

Introduction Focal Impulse and Rotor Modulation (FIRM) guided catheter ablation aiming at stable rotors has been investigated as a treatment option in patients with atrial fibrillation (AF). The objective of this study was to compare the safety and efficacy of FIRM‐guided ablation with second‐generation cryoballoon pulmonary vein isolation (CB2‐PVI) in paroxysmal AF. Methods Consecutive patients (n = 22, mean age 60 ± 11 years, 59.1% of males) who were treated with a stand‐alone FIRM‐guided ablation were included in this retrospective single‐center study. Procedural data and arrhythmia‐free survival at 12 months were compared with n = 86 consecutive patients (mean age 62 ± 13 years, 62.4% of males) who received de‐novo CB2‐PVI. Results Median procedure duration was significantly longer in the FIRM group than in the CB2‐PVI group (152 [IQR 120–176] minutes vs. 122 [110–145] minutes; p = .031). One patient (1.2%) in the CB2‐PVI group and five patients (22.7%) in the FIRM group had vascular access complications. Atrial tachyarrhythmias recurred in 15 patients in the FIRM group and 11 in the CB2‐PVI group. Kaplan–Meier estimation of single‐procedure arrhythmia‐free survival at 12 months was 25% (95% confidence interval [CI] 6%–44%) in the FIRM group and 87% (95% CI 78%–96%) in the CB2‐PVI group (p