The Next Generation FIRM-Assisted Ablation AF Treatment Approach

1. The Next Generation FIRM-
Assisted Ablation AF Treatment
Approach
By: Sanjiv Narayan

2. The Next Generation FIRM-Assisted Ablation AF
Treatment Approach
Sanjiv M. Narayan, MD, PhD, is a research-focused cardiologist who has taught at UCLA and UC
San Diego. Known for having developed next generation atrial fibrillation (AF) care techniques, Dr.
Sanjiv M. Narayan’s work was featured in a recent WDNU article that brought focus to the potential
of AF screening in reducing stroke risks, often tied to irregular heartbeat.

3. The Next Generation FIRM-Assisted Ablation AF
Treatment Approach
One way of monitoring for a proper heartbeat for patients with cardiac conditions is through apps
such as FibriCheck and CardiacSense, with the latter sending the physician an electrocardiogram
when an irregular heartbeat is detected.

4. The Next Generation FIRM-Assisted Ablation AF
Treatment Approach
A more advanced tool is that developed by the laboratory of Dr. Narayan, the head of Stanford
University’s electrophysiology research and AF program. His longtime focus has been on
identifying electrical chaos points within the heart that result in atrial fibrillation. This technology
was developed at the University of California and was licensed to Abbott.

5. The Next Generation FIRM-Assisted Ablation AF
Treatment Approach
The FIRM-assisted ablation approach developed in his laboratory stands for “focal impulse and
rotor modulation,” and involves widespread mapping of the heart ("panoramic") in tandem with
computational analysis. This approach has now been validated by optical mapping of human
hearts and is able to effectively identify rotational (rotors) or focal or electrical sources of fibrillation.

6. The Next Generation FIRM-Assisted Ablation AF
Treatment Approach
Circular in dimension, rotational activity sites (rotors) and focal sources had not been mapped
systematically in the vast majority of patients until the process was made possible by technology
licensed from Dr. Narayan’s laboratory. With rotors precisely mapped, patients can be treated
through a FIRM-assisted ablation procedure that involves application of heat or freezing energy via
catheter.

7. The Next Generation FIRM-Assisted Ablation AF
Treatment Approach
Several newer techniques including Acutus, CardioNXT, Ablacon, Cartofinder and others have
used Dr. Narayan's findings to show similar results of focal and rotational sources. Work is
underway to compare these approaches to find localized drivers for atrial fibrillation to improve
patient therapy.