Hi Paul, I asked my EP about this. He told me it was for folks that are in persistent afib. My EP is planning to go to San Diego for the training.

So good that there is progress in research!!!!!!!

2 people on this site have had firm ablations. We have been following this for over a year. FIRM and the measurement of fibrosis using the UTAH scoring system (DE MRI) to determine the best candidates for ablation are the 2 biggest things that have happened in the last few years. petey

Paul,
Of course I have had ZERO medical training, but it just seems intuitive that the less burning, the better. If they can just hot two spots and you are fixed, that seems like the way to go. My EP just sort of dismissed it, but that was close to a year ago when we discussed that option. Perhaps it was due to the fact that it was so new. I went with the cardiofocus laser balloon. But it seems like the future (immediate future, anyway) seems to lie with FIRM. Good luck!

Bill

I ran accross a more recent video, from the Heart Rhytmn Society meeting of this year (May 2013). In this study, called PRECISE, they are doing the same as FIRM WITHOUT Pulmonary Vein Isolation. If I heard it right, this is being used for patients with paraidoxical AFIB, not permanent afib.

View at: http://www.youtube.com/watch?v=NEsX0rjuDdk

"The PRECISE trial focuses specifically on paroxysmal Afib (However, very high burden paroxysmal Afib, with majority of patients having hypertension and moderate LA enlargement). The CONFIRM trial focused on Persistent cases and the success rate was around 82% - almost the same as in patients with paroxysmal. Based on the FIRM data,the type of AFIB doesn't seem to influence the outcome of ablation that much. The reasons for ablation failure is not new rotor formation, but rather inability to ablate the mapped rotors due to their difficult anatomic location (eg. too close to esophagus, phrenic nerve, etc). Basically, if afib is inducible in the lab and rotors are located in safe spots to ablate your chances of success are very high. "

FIRM was developed for persistent afib as they have found that the more afib burden (time in afib), the higher the likelihood that you have these rotors that can be identified and quickly ablated. They have found out that people have an average of 2.5 rotors and that they can be ablated in minutes. The rotors have been found to make the atria respond with disorganized activity throughout the atria. rather than ablate everything, they believe that ablating the rotors first can determine whether or not more ablating needs to occur. One additional comment I'd like to make is that there isn't much difference between high burden paroxysmal and persistent afib (persistent being defined as 7 day length or more episodes. Also, people may fall into both categories.

Bottom line: Firm has value for either type of afib.


petey

Petey,

Interesting data on FIRM. Do you know what is meant by high burden afib? I assume it relates to a certain percentage or time that you are in afib during a specific period and was curious if you knew these parameters. Also if you are asymptomatic then it seems to me that your burden could only be determined by holter monitoring so I am wondering if there is standard protocol such as 7 or 30 day monitor.

Any insights would be appreciated.

opsyn

Thanks for your insights Petey. The material that you presented was not clear on the videos. Today I had a chance to talk with a nurse at the local afib drs. practice. He's one of the research sites. Seems that you are on the table, under anesthesia for about the same amount of time no matter which approach they use (7 hrs). That kind of convinced me that I'm not yet ready for an abalation. Right now my afib ruins about 1/2 day per week. Up until now, I've been on just 1/2 the minimum dose of metoprolol. I have an appointment this week with a new cardiologist. Seems there are a lot of folks on this site that are doing ok with rhytmn control drugs. One of these drugs may be in my future. Who knows, maybe 5 years from now, they can fix this purely with external laser beams .

AFIB burden means the percentage of time in afib for a given period of time.

Hi Petey,

I know what afib burden is but I don't know what high burden afib paroxysmal is that you referred to. For example, is it being in afib 40% of the time during a 30 day period, or is it more like greater than 50% of time during a 7 day period. Are there any guidelines that define what high burden is.Sorry for the confusion, thanks for your help.

opsyn