Ablation technique destroys eye of the storm

By Piriya Mahendra

Researchers have developed a new technology that could significantly improve the success rate of procedures to treat atrial fibrillation (AF).

The Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation (CONFIRM) trial showed that the FIRM technique achieved AF termination or consistent slowing in 86% of patients, compared with 20% of those who underwent conventional ablation only (p<0.001).

Sanjiv Narayan (University of California, San Diego, USA) and team found that AF is sustained by localized sources or electrical disturbances in the heart called rotors or focal impulses, which the authors liken to hurricanes or the "eye of the storm." It is these sources that FIRM pinpoints for ablation.

"We are very excited by this trial, which for the first time shows that AF is maintained by small electrical hotspots, where brief FIRM guided ablation can shut down the arrhythmia and bring the heart back to a normal rhythm after only minutes of ablation," commented Narayan in a press statement.

His team found that FIRM ablation alone at the primary source terminated AF in a median 2.5 minutes. However, as reported in the Journal of the American College of Cardiology, total ablation time did not differ significantly between the two groups.

After a median follow-up period of 273 days, patients who underwent FIRM-guided ablation had a significantly higher freedom from AF after a single procedure than those who underwent conventional ablation, at 82.4% versus 44.9% (p<0.001).

"The results of this trial, with an 80% ablation success rate after a single procedure, are very gratifying," remarked co-author Kalyanam Shivkumar (University of California at Los Angeles, USA).

"This is the dawn of a new phase of managing this common arrhythmia that is mechanism-based."

The FIRM technology was licensed to Topera Medical, which has recently obtained US Food and Drug Administration clearance for the arrhythmia source mapping system.

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