Dr. Narayans paper on FIRM and the PRECISE Trial

Question

Stopafib.org has just posted Dr. Narayan's new paper on the FIRM ablation's PRECISE Trial with tons of information and amazing results.  Since I have persistent Afib, and the PRECISE trial focuses more on paroxymal Afib, I am not sure whether this will be significant in my case.  I am so excited about being evaluated for this procedure and have high hopes for a cure (or as close as one can expect) for my Afib.  I am 2 weeks out from my last cardioversion and 2 weeks back on the higher dose of Norpace and am starting to again have side effects of dizziness and gastric distress.  I am thankful to be still in nsr, but have been having a lot of rapid  and skipped beats and I kind of hold my breath and hope each time that it isn't another episode.

Also, the Cleveland Clinic has a chat tomorrow (5/31) regarding Afib.  If you miss the actual chat, stopafib.org usually posts the transcript and video about a week later.

DeltaDawn23 · Answer

Thanks Jerry -- all support is appreciated. I have high hopes for this. The alternative -- drugs with huge side effects and no increase (perhaps decrease) in mortality -- doesn't seem like a good deal to me. I just got my post-cardioversion followup moved up to this Thursday, so I can find out about the dizzy spells I am experiencing and see if they mean anything other than scaring me to death:P

Jerry_NJ · Answer

I think since you can get your hear to "run" in NSR for periods of time, even with the need to use drugs there is hope - go for it.

As I understand it those of us who have been in permanent AFib will develop fibrosis of the atrium muscles - and thus the atrium can no longer fully participate even if it gets/generates NSR timing signals.

DeltaDawn23 · Answer

I really appreciate all your input.  I don't think I would be on this path if you had not posted all these amazing results.  With a standard PVI ablation offering me 50-60% success rate and FIRM offering 80% plus, it's a no-brainer!  I just hope I am judged a good candidate for the procedure.  It's sounding like just FIRM might do the job?  I guess I will ask the doctor at my evaluation.  My Norpace is giving me a lot of side effects, I really would like to be off of it.  Even if I had to take a beta blocker I would be happy, it is such a benign med compared to the big gun anti-arrhythmics. Thanks again for all your help.  I will post after my evaluation.

RVVq · Answer

Good luck with your FIRM ablation!

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 we have so far, the type of Afib you have 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. 

Please keep us updated on how your appointment goes! Wishing you a successful ablation and long-term persistent NSR.