Focal Impulse and Rotor Modulation (FIRM) Ablation

Focal Impulse and Rotor Modulation, or FIRM, is a new type of ablation technique used to treat patients with atrial fibrillation. Stanford Health Care is one of the first hospitals to offer this new ablation treatment, pioneered by Sanjiv Narayan, MD, PhD.

Stanford Doctor Shares Breakthrough Afib Care
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Stanford Doctor Shares Breakthrough Afib Care
For decades, doctors worked to control atrial fibrillation in their patients suffering from this debilitating heart disorder. Without a technology to confirm that afib was triggered by identifiable locations in the heart, multiple procedures were often necessary to control afib’s symptoms. Stanford cardiologist Sanjiv Narayan spent several years developing that technology. Called FIRM, this mapping technology pinpoints those locations and then guides doctors to ablation treatment so definitive that it often becomes a one-time procedure. In this video, he shares details of how it works and video of a procedure. Stanford Cardiac Arrhythmia Service - https://stanfordhealthcare.org/medical-clinics/cardiac-arrhythmia-service.html About FIRM Ablation - https://stanfordhealthcare.org/medical-treatments/f/firm-ablation.html About Atrial Fibrillation - https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/atrial-fibrillation.html Stanford Physician: Paul Wang, MD - https://stanfordhealthcare.org/doctors/w/paul-wang.html#summary-content Stanford Physician: Sanjiv Narayan, MD - https://stanfordhealthcare.org/doctors/n/sanjiv-narayan-sanjiv1.html#summary-content

With FIRM ablation, doctors can find the electrical causes of atrial fibrillation in the heart much faster than other ablation methods.

How FIRM ablation works

Ablation is a procedure that uses heat or cold to remove heart tissue causing the harmful activity in the heart. Normally, ablation is used to find triggers of atrial fibrillation in the pulmonary veins of the heart.

FIRM ablation is used to find the exact electrical sources that cause atrial fibrillation, using electrical activity mapping software and new types of electrical mapping probe (catheter). The electrical sources are called rotors, because of their circular shape and spinning motion.

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Patented mapping system

Dr. Narayan helped develop a patented algorithm to map the electrical sources that cause atrial fibrillation with a research grant funded by the National Institutes of Health and other groups. This proprietary mapping system, licensed to Topera Medical, is FDA-approved. Dr. Narayan has an equity stake in Topera, for his work in developing the mapping software.

FIRM mapping and the ablation procedure itself takes about 90 minutes. This may take longer if combined with a pulmonary vein isolation (PVI). PVI is a standard procedure in which cautery lesions are placed around the pulmonary vein to prevent any heartbeats that may trigger atrial fibrillation.

The benefits of FIRM ablation

FIRM ablation destroys less atrial tissue than traditional ablation. We use this treatment for routine clinical care as well as for several clinical trials with or without conventional ablation to treat atrial fibrillation.

Other benefits:

  • FIRM ablation improves the success of PVI by 20%-40%
  • Clinical trials are looking at how much the success of PVI is improved by adding FIRM ablation in different populations.
  • Adding FIRM ablation is also more successful than PVI alone in patients with advanced atrial fibrillation

Can FIRM ablation help me?

Consult with your doctor to see if FIRM ablation is appropriate for you. At the Cardiac Arrhythmia Service, our team will evaluate you to see if you are qualified for FIRM ablation treatment.

One of the main criteria to be a candidate for FIRM ablation is that your left atrium should fit the basket catheters (60mm). If your left atrium is too big, FIRM ablation is not for you.

FIRM at Stanford Health Care

Dr. Narayan, an expert in treating atrial fibrillation, developed the FIRM technique. Overall, Stanford doctors have completed more than 300 procedures.

Stanford Health Care is one of the first hospitals to offer FIRM ablation. As with all procedures, doctors need specialized training and guidance to perform FIRM ablation successfully.

Research about FIRM ablation

In 2013, the FDA approved the mapping catheter used in FIRM ablation. In a study first presented in 2011, the multicenter CONFIRM clinical trial of 107 patients showed that two years after treatment, 86% of those treated with FIRM ablation had not had a recurrence of atrial fibrillation, compared to 44.9% of those who received traditional therapy.

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