Pulsed Field Ablation: A New Treatment Option for AFib

Affecting nearly 5% of the U.S. population, or 10.5 million adults, atrial fibrillation (AFib) is an exceedingly common and growing health concern. According to Dr. Kyle M. Gobeil of Baystate Cardiology, “AFib is a chronic, progressive disease that can lead to serious complication, including stroke and heart failure. As the number of people with AFib continues to rise, innovative treatments are key to transforming care and enabling patients to live successfully with it.”

What is AFib?

The most common irregular heartbeat, or arrhythmia, treated at Baystate Cardiology, AFib occurs when the normal steady rhythm of the heart becomes disrupted.

As Dr. Gobeil explains, “In a healthy heart, the four chambers beat in a synchronized rhythm that keeps blood flowing steadily throughout the body. When the rhythm in the upper chambers, called the atria, gets disrupted, it can lead to AFib.”

AFib is triggered by abnormal signals in the pulmonary veins leading into the heart that cause the upper chambers to quiver or fibrillate. In response, the beat of the lower chambers also becomes irregular, leading to what Dr. Gobeil describes as “electrical chaos” in the heart.

Symptoms of AFib

While many people in AFib experience symptoms including fatigue, shortness of breath, dizziness, chest discomfort, or a racing or skipping heartbeat, 10-40% of people experience no symptoms at all.

AFib is chronic, meaning once it starts, it doesn’t go away. Episodes of irregular heartbeat may initially come and go but eventually become more frequent and last longer. As the disease progresses, blood can become stagnant in the heart, leading to an increased risk of stroke. Structural changes resulting from stretching and scarring of heart tissue can further impair the heart’s ability to receive the electrical signals critical to maintaining a rhythm.

Pulsed Field Ablation: A Better Way to Manage and Treat Atrial Fibrillation

While several effective treatment options for AFib exist, current evidence strongly suggests that pulsed field ablation (PFA) is poised to become the gold standard.

Dr. Gobeil says, “Of course, treatment depends on the individual patient's condition and symptoms, but for those who are candidates for ablation, PFA is currently the preferred option.”

He explains, “Ablation involves inserting a catheter into the groin and threading it up to the affected area of the heart. Traditional ablation methods use heat or cold to create small scars in the heart that block the signals causing AFib. Even though these methods are very safe, they come with a small but significant risk of damage to the esophagus or phrenic nerve. In rare cases, the extreme temperatures used to kill specific cardiac tissue moves beyond the heart and into the adjacent tissue like the esophagus. When this happens, a fistula can form between the heart and the esophagus. While incidents are rare—occurring in .2% of procedures—the risk of dying from a fistula is 60-80%.”

The latest advancement in ablation, PFA eliminates that risk.

“Instead of using high heat or freezing, PFA uses a high-frequency electric current to cause damage at the cellular level and block the bad signals. What makes PFA safer than the other methods is the fact that not all tissues and cells die at the same energy level. PFA uses an electric current specific to heart tissue, meaning there’s no unintentional risk to other organs, including the esophagus.”

In addition, PFA tends to be much quicker procedure than thermal ablation. “Thermal ablation can take up to three to four hours while PFA is consistently completed in two hours,” says Dr. Gobeil. “Less time under anesthesia makes it safer for everyone and provides a viable ablation option for many older patients. Most patients go home the same day.”

Dr. Gobeil emphasizes that AFib is not curable. “The goal of any treatment is effective management of AFib and restoring quality of life. PFA offers the best means to achieve that with the least risk of complications.”