FIRM Catheter Ablation of Atrial Fibrillation Can Stop Afib in Minutes — Video Interview with Dr. Sanjiv Narayan

FIRM Catheter Ablation of Atrial Fibrillation Can Stop Afib in Minutes — Video Interview with Dr. Sanjiv Narayan

By Mellanie True Hills

June 11, 2012

  • Summary: FIRM catheter ablation is a new frontier for atrial fibrillation treatment and was the buzz at Heart Rhythm 2012. In this video, Dr. Sanjiv Narayan provides an update on the results of focal beat and rotor (FIRM) ablation.
  • Reading and watching time is approximately 6 minutes

In this video interview at Heart Rhythm 2012, Dr. Sanjiv Narayan updates us on the progress of his FIRM (focal impulse and rotor modulation) ablation research and what has happened since we last interviewed him in 2011. Since that time, other centers have duplicated his results in ablating rotors and focal beats, effectively wiping out afib in just minutes. This was definitely the buzz at Heart Rhythm Society.

View the video interview with Dr. Narayan (approximately 6 minutes)

Also see our previous video interview with Dr. Sanjiv Narayan in 2011 regarding FIRM ablation: Atrial Fibrillation Focal and Rotor Catheter Ablations Show High Success Rates — Video Interview with Dr. Sanjiv Narayan About the FIRM Trial

To learn more about the eight centers performing the FIRM ablation, please see Dr. Naryan’s profile.

About Sanjiv Narayan, MD:

Professor of Medicine
University of California at San Diego

For more information, see Dr. Narayan’s profile

Video Transcript:

Mellanie True Hills: Dr. Narayan, you’ve really taken Heart Rhythm 2012 by storm this year. And we talked last year, but I’d love for you to update the patient community on the things that have happened since we talked last year.

Dr. Sanjiv Narayan: Thank you so much, Mellanie. The most gratifying and exciting thing for us has been a way of improving the outcomes for our patients with much shorter procedures, hopefully, that will also be obviously much safer all around. So last year, I briefly showed for the first time how we have identified for the first time in humans localized spiral waves, or rotors, and focal beats, which cause afib, such that human afib is much simpler than we thought before. It’s not chaotic waves that require a lot of ablation, but with properly directed targeting, you can target these spiral waves, or focal beats, and eliminate them with just a few minutes of ablation.

Last year, I showed that data in about 107 patients. Since then, we’ve now updated that. From the San Diego series we’ve added more patients, and now we’re very pleased to report that we’ve got an additional more than 30 patients from eight external sites with very experienced investigators who have been doing cases completely independently of the San Diego team. And they’ve shown essentially the same results, with one slight difference; their results were a bit better than ours, actually. We now have the total patient pool and reporting of 154 — I think it’s over 160. All of those patients, but three, showed spiral waves, localized rotors that did not move much, or focal beats, where ablation was able to make a big difference. Our patients had two sources each.

When ablation was applied before any pulmonary vein isolation in a very localized, focused area, in almost a hundred of those patients, those sites, and the whole group, found that afib terminated mostly to sinus rhythm within five minutes of ablation on average in almost seventy percent of those patients. That’s also translated into an improved long-term outcome, and in the patients that we currently have long term follow-up on using those implanted ECG monitors, we’ve got a freedom from afib now at a mean of about a year, and in some patients up to 4 years, of over 82% after one procedure. We’re really gratified by this opportunity to really improve the procedure and make it simpler for our patients.

Hills: It’s absolutely fascinating, and some of the buzz here is that, for example, Sonny Jackman, who was the pioneer of catheter ablation, stood up yesterday and stated how exciting this particular trial was and the results that you guys have had. And yet I’ve heard some of the EP’s talking about their concern as to being a little bit skeptical of it. Why should they believe this data, especially in light of the fact that there have been CFAEs before that have been very exciting, and that hasn’t panned out. Why should they believe this data?

Narayan: I think that it’s an excellent question, and I really appreciate and thank Dr. Jackman for his vote of confidence on our presentations and early publications. I think the skepticism is natural and healthy. It means that you really have to defend your point of view; you have to prove the data – you know, show me the data!

So I would say that this is very different from everything that has come before it for a couple of main reasons: It is based on a very fundamentally-proven mechanism that dates back about thirty years and many experimental preparations; for the first time, we’ve been able to show that in patients. Moreover, for the first time of any ablation procedure, or any surgical procedure, we’ve been able to target those specific mechanisms – the rotors, or focal beats – and eliminate them and shut afib down. Most of the sinus rhythm is within minutes; some of the records — actually in external sites, not my lab — are as short as five to ten seconds of ablation; and more importantly, we then try to get the afib started again and we’ve been unable. And when you implant implantable monitors, these patients are free of afib.

Now, there are some more data that also speak to this – and this is very preliminary – but we’ve now started to do these cases without doing any pulmonary vein isolation at all, so just the FIRM ablation. It’s an early series, patients were recruited as part of a well-regulated research protocol, but in those patients, FIRM ablation alone was able to shut the afib down, and in early follow up, without doing any PVI. So for procedures with ten or fifteen minutes of ablation total, those patients are free of afib. So we do need to validate that in more patients — there are more centers joining this investigational study — but all of these things in aggregate I think make this quite different from what’s come before.

Hills: Well it’s extremely compelling, and we really appreciate you sharing this with the patient community as well. It’s been quite a buzz here at Heart Rhythm 2012, and I’m sure it will be with patients, also. For, this is Mellanie True Hills. Thank you, Dr. Narayan.

Narayan: Thank you so much, Mellanie.