FIRM Ablations

I have previously posted on FIRM (Focal Impulse and Rotor Modulation) ablations which appeared to show very promising results in industry sponsored trials.

However subsequently there was an independent trial (OASIS) which showed that FIRM ablations didn't even have the same success rate as standard RF PVI ablations. This paper was published in the JACC journal.

Now the JACC has retracted the paper which is an extreme and very unusual step. They quote issues with the OASIS trial, which appear to be relatively minor. A number of people smell a rat. There do appear to be numerous conflicts of interest.

Anyone with an interest in the way the pharma industry operates or medical science should read this article by John Mandrola:

medscape.com/viewarticle/86...

9 Replies

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  • "Regular" ablations are highly effective (97-99%) already.

  • Right atrial ablations for atrial flutter are effective about 95% of the time, but it's the left atrium which produces AF. The success rate for that is only 60-70% at best.

  • I would hate to get anyone overly optimistic with a 97-99% success rate. I don't believe any of the procedures for Afib come close to that.

  • They indeed do according to: en.m.wikipedia.org/wiki/Cat...

    But perhaps that is just in the UNITED STSTES where we have superior (i.e non-socialized) medicine.

  • In the article you quote it says "For SVT and atrial flutter, the success rates are 95-98%" and also "For atrial fibrillation, several experienced teams of electrophysiologists in US heart centers claim they can achieve up to a 75% success rate. However one recent study claims that the success rates are in fact much lower. Single procedure success rates have been published in this study at 28%. Often, several procedures are needed to raise the success rate to the 70-80% range"

    That's exactly in line with the figures I quoted for the UK.

  • I read your wiki article and as Mark S replied, the success rate for a single catheter ablation for aFib is lower than 75% . I have had two ablation procedures at the Duke University Heart Center in North Carolina - one of the best in the US and both were unsuccessful. To the tune of $120K and $100K later, I would strongly refute that the US privatized medical system is superior to most other industrialized countries. It would appear reading comprehension is a little lacking there as well.

  • Sorry but this is not what the article says. Also if you go to the point it says "For SVT and atrial flutter, the success rates are 95-98%.[citation needed] and if you hover over the citation needed box it says "This claim needs references to reliable sources (March 2009)."

    The mere fact that these have not been provided in over 7 years surely means that they don't exist. You can bet that if an EP was getting anywhere near that number they would have provided the reference, would be shouting it from the roof tops and personally be making a million dollars a year plus because they were so much better than their peers.

    If you look in the American medical publications, the European ones and the British ones they all are very close with their success rate numbers.

    By the way Wikipedia is a very useful resource but it is an open editing resource and wrong information has been input by people and in some cases it can take quite a lot of effort to get it corrected. I know because I have not only seen it written but also had to get things corrected for a client.

  • The NIH says 89% in normal sinus ryhthm one year after ablation: ncbi.nlm.nih.gov/pubmed/228...

  • Yes but the 89% figure only comes from prospective studies. In that paper it says that a meta analysis of six papers came up with 76% still in NSR.

    Also that paper only looks at ablations performed at the same time as major cardiac surgery - i.e. you're split right down your chest and your heart is exposed. That requires weeks of recovery time in hospital compared with a day for an RF ablation on its own. It's very similar to the maze procedure to stop AF which scars the heart as part of heart surgery for separate ailments. That has a success rate of around 75%.

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