Atrial fibrillation (AFib) affects over 10 million people in the US, making it the most common arrhythmia in the nation.Researchers estimate that three to five individuals over the age of 45 will develop Atrial Fibrillation during their lifetimes, and men face a 1.5-fold higher risk than women. Traditionally, the chosen approach for this common arrhythmia involved the use of heat or cold gas—two methods that, although effective, could potentially damage surrounding heart tissue. Today, doctors are introducing Pulsed-Field Ablation as a newer alternative technique.PFA is a minimally invasive treatment that allows doctors to treat specific areas while preserving the integrity of surrounding tissue, and enables patients to return to their normal lives more quickly.
What Is Atrial Fibrillation?
Atrial fibrillation is an irregular, often very rapid heart rhythm that can lead to blood clots in the heart and increase the risk of stroke, heart failure, and other heart-related complications. The heart has four chambers: its upper two chambers are the atria, and its two lower chambers are the ventricles. Every heartbeat begins with an electrical signal from the sinus node, located in the right atrium. This signal travels through the atria and then to the ventricles, causing the heart to beat steadily. In AFib, these signals become chaotic, and the atria quiver rather than beating normally. People with AFib can have heart rates of up to 175 beats per minute.
Traditional Approaches to AFib
The catheter has played a key role in allowing doctors to reach vital structures without performing open-heart surgery. For instance, doctors widely use Coronary Angioplasty and Coronary Stenting to open blocked arteries. In this procedure, a balloon is used to widen the artery, and a heart stent, made of wire mesh, is placed in the artery to ensure blood can flow freely to the heart. Catheters are also widely used to treat AFib through minimally invasive procedures. Until very recently, the two traditional techniques used to treat AFib were radiofrequency ablation and cryoablation. In Radiofrequency Ablation, doctors insert a catheter through a vein in the groin and guide it to the atria, where the catheter tip delivers high-frequency electrical current and produces heat.The heat burns small areas of heart tissue, creating scars that block abnormal electrical signals. Cryoablation is similar, except that cold gas rather than heat is used to create scarring.
The New Pulsed-Field Ablation Technique
Pulsed-field ablation (PFA) is a new, cutting-edge approach to treating AFib without heat or cold. Like its earlier counterparts, it is a catheter ablation technique; the difference is that it relies on brief, high-energy electrical pulses to destroy targeted heart tissue. PFA works through electroporation—a process in which electrical impulses create tiny holes in the cell membrane.If doctors apply sufficient energy, it can cause irreversible cell damage, which they aim to achieve when treating Atrial Fibrillation.
The Benefits of PFA
Although radiofrequency ablation and cryoablation effectively induce the scarring needed to stop AFib in its tracks, PFA offers much greater safety in protecting surrounding tissue. The older techniques can damage nearby structures such as the esophagus, the nerves controlling the diaphragm and stomach, and the pulmonary veins. The main benefit of PFA is that it reduces these risks by allowing doctors to target heart tissue more selectively. PFA also reduces procedure time. While traditional ablation can take between three and five hours, PFA takes just one to three hours. Moreover, studies have shown that PFA is as effective as traditional ablation for treating AFib.
Who Can Benefit from PFA?
Doctors currently use PFA to treat patients with persistent AFib, especially those experiencing symptoms from Atrial Fibrillation. They also use it to treat patients who have both AFib and Congestive Heart Failure, as well as those who cannot tolerate or prefer not to take AFib medications. Those falling under these categories typically see an electrophysiologist, who can advise them not only on PFA but also on the optimal way to manage the arrhythmia. Doctors may also advise additional strategies, including lifestyle changes such as treatment for Sleep Apnea.
Atrial fibrillation is a problem affecting millions of people across the world. Traditional methods of treating this condition include heat or cold to destroy heart cells and create therapeutic scar tissue. A novel technique that promises greater safety is PFA, which allows doctors to target tissue more selectively while reducing potential damage to surrounding tissues.