Atrial fibrillation – commonly called Afib on TV doctor shows and in real hospitals – is the most common heart rhythm disorder, sending millions into a frantic waltz of skipped beats and palpitations that increase the risk of stroke.
Happily for the millions of Americans afflicted with this condition, a new, recently approved treatment called Pulsed Field Ablation has given doctors an additional tool to remedy the problem that is highly effective and safer than existing techniques.
“During Afib, the top chambers of the heart beat in an irregular rhythm, out of sync with the heart’s lower chambers due to faulty electrical signals, which interferes with the heart’s function.
While some individuals experience no symptoms at all, others may experience a fluttering or pounding heartbeat along with chest pain, weakness, fatigue, dizziness, shortness of breath or stroke,” according to Michigan Medicine, the academic medical center at the University of Michigan.
“Cardiac ablation is a minimally invasive procedure that kills selected cells to create scars to stop the errant electrical impulses that cause irregular heart rhythms,” according to Cleveland Clinic.
Pulsed Field Ablation (PFA) is an emerging non-thermal technique for treating cardiac arrhythmias such as atrial fibrillation. Unlike traditional ablation methods that use extreme heat or cold, PFA employs high-voltage electrical pulses to electively target cardiac cells, while sparing surrounding tissues.
“Over the last 20 years, the majority of ablation that has been performed has been done with a thermal method, where you use a heat or a cold or a freezing method to perform the procedure,” said Dr. Brett Faulknier, an electrophysiologist at Cleveland Clinic Indian River Hospital.
“Radio frequency ablation involves using heat, and cryo ablation involves freezing of the tissue.
Both have been very successful for us over the years.
“But one thing that is always a downside to using that type of technology is the risk of damaging tissue that is near the areas where you’re trying to provide the therapy with the thermal method of ablation. With Pulsed Field Ablation, you can potentially avoid damage to other nearby structures because the PFA catheter works by pulsating the cells at a specific frequency that will ultimately result in a localized cell death of the specific cells that you are targeting.”
The FDA approved the first PFA system for the treatment of atrial fibrillation 14 months ago.
That same month, Cleveland Clinic enrolled the first patients in a randomized trial comparing PFA with anti-arrhythmic drug therapy for first-line treatment of persistent Afib.
Researchers found that this non-thermal ablation method treats Afib with good durability and faster procedure times than conventional ablation techniques and lowers the risk to adjacent tissue.
According to the American Heart Association, PFA delivers microsecond-duration electrical pulses that create pores in the cell membranes of targeted cells that leads to cell death. This process, known as irreversible electroporation, disrupts the electrical pathways responsible for arrhythmia without relying on thermal energy. By selectively targeting cardiac cells, PFA reduces the risk of injury to surrounding tissues and adjacent structures like the esophagus, phrenic nerves and coronary arteries.
“The procedure is very similar to the way we’ve always done the procedure,” Dr. Faulknier explained. “Getting to that area in the left upper portion of the heart or the left atrium still involves threading a catheter through the venous system. We generally use both the right and left venous systems because we’ll bring several catheters into the heart that we use not only to do the ablation but to also provide recordings of other portions of the heart.
“Usually, three to four catheters are inserted, including a catheter that performs like an echocardiogram from the inside of the heart where we can watch what we are doing. A good portion of the procedure is actually spent getting to the area to perform the ablation. Once you achieve that, you deploy a Pulsed Field Ablation caterer to do the ablation.”
At Cleveland Clinic, PFA is used for ablation of the pulmonary veins. Most people have four pulmonary veins that carry blood from the lungs and dump into the left atrium. The veins are lined with electrical wiring that transmits electric signals that when faulty can trigger atrial fibrillation.
The ablation creates a scar around the opening of each of these pulmonary veins, creating a roadblock that prohibits errant signals from coming through the walls of the veins and affecting the left atrium, blocking the impulses that cause Afib.
“We use the catheter to deliver eight applications of the pulse field energy for each vein, moving between a basket configuration and a flower configuration by an adjustment in the handle of the devise.” Dr. Faulknier continued.
“Research shows that delivering eight ablations in that very specific order achieves irreversible electroporation and leads to the cell death of these specific cells that are in contact with the electrical field.”
In most cases, patients go home the same day as the procedure and are instructed to refrain from strenuous exercise for a week. After that they can resume their daily routines.
“People are finding there is less associated discomfort of the chest with this form of ablation therapy, and we are having a very high level of success with it,” Dr. Faulknier said.
“Studies show that the overall freedom from atrial fibrillation after one year is 73 percent in the paroxysmal population and 53 percent in persistent atrial fibrillation, with less than 1 percent rate of major adverse events.
“This is one of the biggest advancements in the field of atrial fibrillation in the last 20 years and it’s a gamechanger going into the future for ablation of atrial fibrillation.”
Brett Faulknier, D.O., is an electrophysiologist at Cleveland Clinic Indian River Hospital. He specializes in procedures that help people with atrial fibrillation, atrial flutter and other abnormal heart rhythms. He is fellowship-trained in cardiovascular disease and cardiac electrophysiology. He sees patients at the Rosner Family Health and Wellness Center. His office can be reached at 772-226-4830.
