Report: FIRM Mapping System—Should Ablation Patients Avoid It?

The FIRM mapping system was a hot topic at the last annual AF Symposium. In his presentation Dr. Ravi Mandapati compared data from his study of FIRM ablations performed at UCLA Medical Center to the CONFIRM clinical trial data published by Dr. Sanjiv Narayan, one of the inventors of the FIRM mapping system.

Topera-FIRMap catheter - three sizes

Topera-FIRMap catheter (three sizes)

Up to this point in time, everyone seemed to be jumping on the FIRM/Topera ‘bandwagon’ with very little critical analysis or understanding of how it worked.

As patients, we should now be skeptical of the FIRM system:

• It doesn’t map nearly ½ of the left atrium
• The FIRM mapping algorithms finds stable rotors that other research finds are not stable, and electrophysical characteristics that other research doesn’t confirm
• Results of ablating FIRM-identified rotor sites are relatively poor. (This is what should most concern us as patients.)

So, as an A-Fib patient, you may ask: “Should I now stay away from doctors or centers using the FIRM system?” Read my answer and my full 2015 AF Symposium report at Critical Analysis of the FIRM Mapping System.

For more background also see my 2014 AF Symposium report: ECGI vs. FIRM: Direct Comparison, Phase/Waveform Mapping.

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