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FIRM Ablation Of Atrial Fibrillation

This new procedure may be the "Holy Grail" of Afib Ablations. This simplified treatment for Atrial Fibrillation may soon replace the long and debilitating 3 hour plus Afib Ablation process as we know it!

Southern California Cardiologist/Electrophysiologist Dr. Sanjiv Narayan may make himself famous with his fantastic new procedure for ablating Atrial fibrillation.  His amazing and ground breaking work FIRM Ablation of atrial fibrillation, may finally be the relatively simple and less time consuming technique that stops Afib in it's tracks.  Some remain skeptical.  I say less burn and faster ablations could be a God send to afib sufferers everywhere.

"Rotors and Nests" - the new stuff now on what causes Atrial Fibrillation today.

It has recently become understood that electrical "rotors" and nests of focal impulses play an important role in Afib.  These notions of spinning waves of electricity, rooted deeply in complicated matters of optics and physics, have always been seen but deemed far too complicated and not clinically relevant enough to warrant much attention.

Most "regular" ablationists have felt the same. The old story has always been where, how much, and in whom to burn.  Afib ablation has been about building electrical fences around pulmonary veins - pulmonary vein isolation - P.V.I. was always thought to be the key.  That ain't easy, so like my Doctor, the idea was to get burnin' and BURN,BURN,BURN so as to have the best hope of stopping the errant electrical impulses that cause Atrial Fibrillation.

Now it seems these types of ablations may have been missing a key aspect of physiology.  Dr Narayan's work changes that.  By targeting rotors and focal impulses - which he and others believe important in keeping Afib going - his work may move closer to the root cause of the Afib.  And if it does, that may enable doctors to drastically shorten procedures and at the same time improve outcomes - thank you very much.

What is FIRM Ablation?

The technique involves placing commercially available multipole basket catheters into the atria. During Afib, the thousands of signals collected are sent to an computer system, which then displays optical images and movies of the process.  Distinct geographic "areas of interest" in either the right or left atrium can be seen in almost all cases of Afib. Sometimes the rotors are located in areas typically targeted during pulmonary vein isolation (PVI), but in many cases they are not.

Remarkably, prior work has shown that when these areas are ablated, Afib STOPS!  Amazing, but it's not all.  Patients who have undergone focal impulse and rotor modulation (FIRM) ablation in addition to standard PVI remain Afib free more often than those treated with standard PVI.

Dr. Narayan presented has new data on the acute termination of Afib with FIRM-guided ablation.  In a many patients with advanced Atrial Fibrillation, he showed that rotors or focal impulses could be seen in 98%.  Ablation at these focal sites terminated, slowed, or converted Afib to flutter in 88% of patients.  Almost half converted to sinus rhythm.  In one case, ablation for only one minute converted the patient to normal sinus rhythm.

Keep in mind he is ablating focally and terminating Afib before the PVI.  Contrast this with the work of others that terminate Afib after PVI and (hours of) extensive linear ablation.  Dr Narayan has none of that.  His magic entails "finding the spot".

Good news Dr. Narayan now has a group of eight labs using his proprietary system.  One of the senior leaders was impressed and mused: "This was the real deal."

Also, he showed a couple cases of using FIRM ablation only, without PVI proved effective.  It's too early to tell, but this would be incredible - a complete change?

What Now?

Doctors doing Afib ablations have heard similar stories before.  Ablating at sites of complex fractionated electrical activity (so-called CFAE) held similar promise.  This strategy has not proven successful.  There have also been boastful labs from across the globe purporting 100% success in one-hour cases.  They have never panned out.  The Afib docs, therefore, stay skeptical.

The next step with FIRM ablation must be to show that others can see the rotors that Dr Narayan does.  That the proprietary software will work in other labs.  And of course, the ultimate test will come when it is tested in randomized multicenter clinical trials.

I personally have had TWO 3 hour plus Afib - P.V.I. - ablations.  I am in remission of my Afib at present - THANK GOD...  But, If I ever have to get another one sign me up for a FIRM Ablation.


Original Posted May 10, 2012 at 07:12 AM, EDT by John Mandrola  Original Article

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