Can Advanced Mapping Improve AFib Ablation? The EMPIRE-AF Study

By: Chad Hanson | August 19, 2026 | 9 min. read |

University of Miami Miller School of Medicine researchers are testing whether an advanced heart-mapping technology can identify the electrical signals driving persistent atrial fibrillation and improve catheter ablation outcomes.

For patients living with persistent atrial fibrillation (AFib), catheter ablation can be life changing. Yet, despite decades of advances in technology and technique, many patients continue to experience recurrent arrhythmias after treatment. Researchers at the University of Miami Miller School of Medicine are investigating whether a new precision-mapping approach can improve those outcomes by identifying the unique electrical signals driving AFib in individual patients.

The effort is underway through EMPIRE-AF, a clinical trial evaluating an investigational technology known as electrogram morphology recurrence (EMR) mapping. The study will determine whether using EMR mapping to guide ablation decisions can improve the likelihood of maintaining a normal heart rhythm compared to current standard-of-care treatment.

Interested in Learning More About the EMPIRE-AF Clinical Trial?

Researchers at the University of Miami Miller School of Medicine are studying whether an advanced mapping technique can help identify the electrical signals that sustain persistent atrial fibrillation and improve catheter ablation outcomes.

Contact the EMPIRE-AF Research Team

📞 305-243-6519
📞 786-320-1940
✉️ [email protected]

Participation is voluntary, and the study team can answer questions about eligibility, risks and what participation may involve.

Why Existing AFib Ablation Often Falls Short

AFib is the most common sustained heart rhythm disorder, causing rapid and disorganized electrical activity in the heart’s upper chambers. For patients with persistent atrial fibrillation, the condition can significantly affect quality of life while increasing the risk of stroke, heart failure and other serious cardiovascular complications.

Since the late 1990s, the cornerstone of AFib ablation has been pulmonary vein isolation, a procedure designed to electrically isolate tissue around the pulmonary veins, where abnormal electrical activity frequently originates. While that approach has helped countless patients, its effectiveness remains limited, particularly among those with persistent AFib.

Persistent atrial fibrillation is a form of AFib that does not stop on its own and typically requires medical intervention to restore a normal heart rhythm. Unlike intermittent forms of AFib, persistent disease is associated with lower catheter ablation success rates and remains one of the most challenging arrhythmias to treat effectively.

Dr. Jeffrey Goldberger in white clinic coat — Dr. Jeffrey Goldberger is principal investigator of the EMPIRE-AF trial.

According to Jeffrey Goldberger, M.D., cardiac electrophysiologist and professor of cardiovascular medicine at the Miller School and principal investigator of EMPIRE-AF, pulmonary vein isolation succeeds in approximately 70% to 80% of patients with intermittent AFib but only about 50% to 60% of patients with persistent disease.

“Not bad. But also not great,” Dr. Goldberger said. “If you’re coming for a procedure to cure your atrial fibrillation, if you’re in that 50-60%, you’re happy. If you’re in that other 40-50%, you’re very unhappy.”

Part of the problem, he explained, is that physicians lack a reliable way to determine precisely what is sustaining AFib in a specific patient.

“Everybody just does empiric pulmonary vein isolation,” Dr. Goldberger said. “Does that mean that your AFib comes from the pulmonary veins? No.”

When standard ablation fails, physicians often add additional treatment targets based on experience or theories about where AFib may be originating. However, those decisions are frequently based on generalized assumptions rather than patient-specific electrical mapping.

The Search for a Better Solution

Most cardiac arrhythmias can be mapped before treatment, allowing physicians to identify exactly where abnormal electrical activity originates. AFib presents a unique challenge because the rhythm changes constantly, preventing doctors from using traditional, time-based mapping techniques that work for more organized arrhythmias.

“We really have no way to map the arrhythmia and find where it’s coming from in an individual patient,” Dr. Goldberger said. “That’s the limitation our study is confronting.”

Frequently Asked Questions About the EMPIRE-AF Clinical Trial

What is persistent atrial fibrillation (AFib)?

Persistent AFib is a form of atrial fibrillation that does not stop on its own and typically requires medical treatment or procedures to restore a normal heart rhythm. It is often more difficult to treat than intermittent forms of AFib.

What is catheter ablation?

Catheter ablation is a procedure used to treat abnormal heart rhythms. Physicians use specialized catheters to deliver energy to targeted areas of heart tissue involved in sustaining the arrhythmia.

Why doesn’t AFib ablation work for everyone?

While catheter ablation can be highly effective, outcomes are less predictable for patients with persistent AFib. Researchers believe this may be because physicians currently lack a reliable way to identify the specific electrical signals sustaining AFib in each individual patient.

What is EMR mapping?

Electrogram morphology recurrence (EMR) mapping is an investigational technology that analyzes recurring electrical signal patterns within the heart. Researchers are studying whether it can help identify areas responsible for sustaining AFib and improve treatment planning.

How is EMPIRE-AF different from standard treatment?

All participants receive standard pulmonary vein isolation. Patients assigned to the investigational group also receive EMR mapping, which may identify additional areas that could benefit from targeted ablation.

Will everyone receive the new mapping technology?

No. EMPIRE-AF is a randomized clinical trial. Participants are assigned to treatment groups so researchers can compare outcomes between standard care and EMR-guided treatment approaches.

Who may be eligible to participate?

The study is enrolling patients with persistent atrial fibrillation who are being evaluated for catheter ablation. Final eligibility is determined by the study team and treating physicians.

How can I learn more about the study?

To discuss eligibility or learn more about participating, contact the EMPIRE-AF research team at 305-243-6519 or 786-320-1940, or email [email protected].

EMR mapping was developed to address that problem. Instead of analyzing electrical timing, the technique evaluates recurring patterns in the shape and frequency of electrical signals recorded throughout the atria. Researchers believe locations with highly repetitive, fast signals may represent the electrical drivers sustaining AFib.

“EMR mapping uses what we call morphology-based mapping,” Dr. Goldberger said. “We look at how frequent this most common morphology appears and then how fast it is.”

Previous EMR studies found that pulmonary veins remained the primary source of AFib drivers in approximately 60% of patients, while the remaining 40% appeared to have important driver locations elsewhere in the heart. Those findings suggest that a significant subset of patients may benefit from a more individualized treatment strategy.

Testing Precision-Guided AFib Treatment

EMPIRE-AF is enrolling patients with persistent atrial fibrillation and randomly assigning them to receive either EMR-guided ablation or standard-of-care treatment. All participants receive pulmonary vein isolation. Patients in the EMR-guided group may also undergo additional targeted ablation if mapping identifies hotspots outside the pulmonary veins.

The goal is to determine whether precision-guided treatment can improve long-term outcomes compared to conventional catheter ablation alone. Researchers have already enrolled approximately one-third of their initial target population and report that the study is progressing smoothly.

Potential Implications for Patients

Researchers hope that identifying AFib drivers with greater precision could substantially improve treatment outcomes. If successful, EMPIRE-AF could help shift AFib care away from broad, empiric treatment strategies and toward precision medicine approaches tailored to each patient’s unique disease process. For patients who currently face uncertain outcomes after catheter ablation, that could represent a meaningful advance.