FIRM Ablation: Mapping the Heart to Treat Atrial Fibrillation

Haroon Rashid, MD, is board certified in cardiovascular disease and clinical cardiac electrophysiology. He is the medical director of Atrial Fibrillation Ablation and Research at the Inova Heart and Vascular Institute. Read Dr. Rashid’s profile.

Atrial fibrillation (AFib) is a common heart rhythm problem that affects 33.5 million people worldwide. At the Inova Heart and Vascular Institute, we are using state-of-the-art technology to treat the condition, including a promising new system called Focal Impulse and Rotor Modulation (FIRM) ablation.

In AFib, the electrical signals in the upper chambers of the heart fire in an uncontrolled manner. This prevents the heart from squeezing blood properly into its lower chambers.

Symptoms of AFib include:

• Fatigue
• Shortness of breath
• Irregular pulse
• Heart palpitations (the feeling of a rapid or fluttering heartbeat)

Untreated, AFib can lead to congestive heart failure and stroke.

What is Atrial Fibrillation Ablation?

In some cases, we can control AFib with drug therapy. But for patients who don’t respond to medications, we treat the disorder with a procedure called ablation.

During ablation, we insert a thin tube, or catheter, into the groin. We then guide the catheter through the blood vessels and into the heart. There, we apply heat or cold energy to destroy the tiny amount of heart tissue where the abnormal electrical signals originate.

The abnormal electrical signals that trigger AFib commonly come from the pulmonary veins. These are the veins that deliver blood from the lungs to the heart. In cases like these, we typically treat the condition by using ablation to eliminate the faulty electrical signals from the pulmonary veins.

But for many patients with AFib, treating the pulmonary veins alone isn’t enough to effectively suppress AFib. That’s particularly true for patients who have persistent AFib or those who have had previous ablations that weren’t successful. In these patients, we perform additional ablation to boost the chance of regaining normal heart rhythm.

FIRM Ablation

Using FIRM ablation, we’re now able to take a personalized approach to treating AFib. AFib is like an electrical storm—and each cluster of abnormal electrical activity is like the eye of the hurricane. With FIRM, we can map the clusters in a patient’s heart.

Like traditional ablation, the FIRM procedure uses a catheter to detect electrical signals throughout the heart—with an important difference: Data collected by the catheter is combined with a 3D mapping system, allowing us to precisely identify and destroy each cluster of abnormal electrical signals. This system helps us to find electrical hot spots that are not visible using standard ablation procedures.

Inova: A Leading Center for FIRM Ablation

We began using the FIRM procedure in 2014 and have been pleased with the results. This is an excellent option for patients who have persistent AFib, those who haven’t responded to traditional ablation and those who have medical reasons that make them poor candidates for traditional ablation.

The Inova Heart and Vascular Institute is now the leading center for FIRM ablation on the East Coast. This technology is perfectly aligned with our goal of providing patients with the latest technologies and the best in personalized care.