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
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
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
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?
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.