Developments in Treating and Understanding Atrial Fibrillation

For patients suffering from symptoms of Atrial Fibrillation, everyday life can be greatly interrupted. We’ve shared stories of AFib patients who thought they were going to have to give up their careers, but weren’t ready to retire. Another patient couldn’t explain why he suddenly had no energy past 4pm. Some patients have lived with the fear of AFib episodes for 20 years, before being told there was something that could be done about it. Today, new developments in treating and understanding Atrial Fibrillation bring more hope to patients seeking an answer for their AFib.


A four year trial comparing the long-term results of blood thinning medication therapies versus the left atrial appendage closure device, WATCHMAN, in AFib patients finds encouraging outcomes for the WATCHMAN device. Analyzing the primary endpoint, the combined rate of all stroke, cardiovascular and unexplained death, as well as systemic embolism, occurred in fewer WATCHMAN patients than warfarin patients, 2.3% to 3.8% respectively during the trial. “This is a monumental proof of concept that the left atrial appendage (LAA) is truly the source of stroke in patients with non-valvular AF,” says Oklahoma Heart Institute cardiac electrophysiologist Dr. David Sandler.  “For years we have been anticoagulating patients to prevent clot in this very small part of the heart in order to reduce stroke and systemic embolization.  WATCHMAN 4-year data now give us proof that delivering localized therapy by obliterating the appendage reduces mortality and stroke over long-term anticoagulation.” 

With a demonstrated mortality benefit of the WATCHMAN closure device over blood thinner medication therapy, will this change treatment of stroke risk for AFib patients? Dr. Sandler says this trial gives providers the evidence needed to help more patients. “Anticoagulation is highly under-prescribed to AF patients,” Dr. Sandler says. “Probably only 50-60% of AFib patients indicated for anticoagulation receive blood thinners.  The new oral anticoagulants will likely make a small dent in this statistic, but many patients are still appropriately concerned about the risks of these agents.  We now have a way to protect more patients from a devastating stroke.   LAA occlusion will likely be used in patients with both high risk of bleed and high risk of stroke.  Over time, improved up-front safety of the procedure may make LAA occlusion a first-line therapy and will likely begin to replace long-term anticoagulation.”

FIRM Ablation

Meanwhile, improvements in technology and software development are helping providers increase the success rate of curing AFib through ablation. FIRM is an acronym for Focal Impulse and Rotor Modulation.  Dr. Sandler explains how FIRM is changing the way cardiac electrophysiologists are performing ablations. “FIRM ablation uses proprietary software to transform information gathered from a basket catheter to demonstrate rotors of activation in the atrium of interest,” says Dr. Sandler.  “The majority of AFib ablation performed today is targeted at the triggers of AFib - predominantly from the pulmonary veins.  This works well in paroxysmal (short lived) AFib.  Results of pulmonary vein ablation are sobering, however, in patients with persistent AFib.  With FIRM ablation, instead of targeting the triggers of atrial fibrillation from the pulmonary veins, we can now visualize the propagating wave fronts of atrial fibrillation in the human.  Early results suggest that targeting rotors with FIRM ablation can improve success in these patients.”
Utilizing this new software, FIRM ablation gives electrophysiologists a view they have never had before this technology. “FIRM takes seconds of live data and recreates the wave fronts in the atrium in a way we have never been able to see outside of computer modeling and animal studies,” shares Dr. Sandler.

Oklahoma Heart Institute cardiac electrophysiologists Dr. David Sandler, Dr. Craig Cameron and Dr. Gregory Cogert treat patients with Atrial Fibrillation. If you have questions about your AFib or believe you may have AFib, please call Oklahoma Heart Institute at 918-592-0999. 

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