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Stanford University School of Medicine

A new tool to treat atrial fibrillation

The first time Susan Klein’s heart stopped, and then started again, she was very frightened. But she didn't run for the phone to call a doctor. Klein had a pretty good idea of what had happened: Six other women in her immediately family had experienced heart palpitations, or, what they called “the little mouse running around their chest,” Klein said. “I had a history — and it was to be expected in my family.”

Klein’s palpitations, however, became so frequent and debilitating that, even with medication, she didn’t have enough breath to make it across a street. By then, of course, she knew that her diagnosis was officially atrial fibrillation, an irregular heartbeat most often called afib. More than two million people in the United States and an estimated 30 million worldwide suffer from what is the most common type of heart rhythm disorder. Before I interviewed Klein this year for a Stanford Health Care video, I was naïve about the seriousness of afib and the challenge of treating it with any certainty of full recovery.

Afib symptoms can include shortness of breath, weakness, fatigue, heart palpitations, light-headedness, and chest or abdominal pain. Some patients with afib feel no symptoms – making it more difficult to diagnose the disease early enough to prevent its most serious consequences: an increased risk of heart failure and a five-times-more-likely incidence of stroke. Afib accounts for about 15 percent of strokes in the United States.

Afib in some people can be managed with medications. Those didn’t work for Klein. Ablation, the standard interventional procedure, often had to be done more than once or even several times. That wasn’t good enough for Klein. “To spend six to seven hours under general anesthetic with only a 40 percent success rate? I wasn’t satisfied,” she said.  Then she heard about Sanjiv Narayan, MD, PhD, a Stanford doctor with a very particular specialty: cardiac electrophysiology. Narayan, who now directs Stanford’s atrial fibrillation program and its electrophysiology research, had long been interested in detecting the points of electrical chaos in the heart that cause afib.

As a board-certified doctor who also has advanced degrees in neuroscience and software engineering, Narayan’s two decades of research and development produced an important new tool: FIRM-assisted ablation. FIRM — focal impulse and rotor modulation — is a combination of optical mapping, based on computational analysis, which pinpoints the exact electrical sources of the fibrillation within the heart’s tissues. Those sources, called rotors because of their circular shape, can then be destroyed with heat in a catheter-based procedure. The rotors had long been suspected, but never before mapped as distinctly as Narayan’s new patented technology was able to do.  With that improved precision, most patients treated with FIRM-assisted ablation need have only one procedure to end their afib. Narayan’s technology also showed that some afib activity would also be found on the left side of the heart, changing what had been a right side only focus of treatment.

Klein couldn't be happier. “Now, I am really great. I can list 10 things that I can do now that I couldn’t before. And just the other day, I ran up a steep flight of stairs. My endurance is a million times better.”

Previously: Using “big data” to improve patient care: Researchers explore a-fib treatments

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