By David Marks
Our world thrives on innovation. New breakthroughs make our lives safer, easier and more rewarding. In 2024 alone, advances included a true robotic lawn mower, a device that converts any pedal bike into an e-bike and even a smart litter box that monitors cat health.
But along with these inventions, an important, new medical development is revolutionizing treatment for the serious health condition known as atrial fibrillation (AF)—which affects adults all across the country and the world. In fact, projections are that by 2030, more than 12 million people in the U.S. will have AF.
“In AF, the atria will quiver and beat fast and cannot pump the blood effectively to the lower chambers of the heart – increasing the risk of stroke, heart failure and death,” said Obada Al Chekakie, MD, MSc, FACC, Cardiology, Clinical Cardiac Electrophysiology, AdventHealth Medical Group Cardiology and Cardiovascular Surgery at Shawnee Mission.
Atrial fibrillation can be caused by:
- Heart conditions: coronary artery disease, heart valve disease, congenital heart defects, and heart attack.
- Lifestyle factors: smoking, obesity, physical inactivity and excessive alcohol consumption.
- Medical conditions: high blood pressure, thyroid disease, diabetes, sleep apnea, and lung disease.
Even though there are many factors that can cause AF, there has been only one, primary procedure—called ablation—to treat it for the past 30 or more years.
“The first line of treatment is ablation, a procedure that can correct heart rhythm problems, also known as arrhythmias, by removing the tissue that’s causing the abnormal rhythm. This can help restore a normal heart rhythm, and can improve the symptoms, quality of life, and chances of survival for many patients with AF,” said Dr. Al Chekakie.
Ablation procedures treat the tissue causing AF symptoms by attacking the cardiac cells electrically:
- Radio frequency ablation uses heat to cauterize (burn) cells around the pulmonary vein that trigger AFib.
- Cryoablation uses extreme cold to achieve the same goal.
There is a downside though. While these procedures can be very effective, standard ablation can also carry a risk of complications including bleeding, perforation, and damage to the esophagus, phrenic nerve (which controls the diaphragm and is essential to breathing), blood vessels and heart valves.
Thanks to PFA, it’s a brand new day
In January, 2024, the U.S. Food and Drug Administration approved the Pulsed Field Ablation (PFA) system, a technique that uses ultra-short electrical pulses to target and eliminate the tissue responsible for atrial fibrillation. PFA offers a potentially safer and more effective alternative to traditional ablation methods by sparing non-cardiac tissues and reducing collateral damage.
During a PFA procedure, the cardiac electrophysiologist threads a thin tube called
a catheter through a patient’s veins from the groin or neck to the upper chamber of the heart. There, the instrument releases electromagnetic waves into the cardiac tissue responsible for AF. By a process called electroporation, the waves make microscopic holes in the cell membranes, so electrical impulses can’t cause AF.
“Almost any AF patient is a good candidate for PFA. It is safe and effective in eliminating the triggers for AF without the risk of damaging the esophagus or the phrenic nerve. The PFA procedures are generally faster, and the patients are less likely to have chest discomfort or fluid overload after the procedure,” said Dr. Al Chekakie.
Without treatment, AFib can progress and become more challenging to treat. For most patients who are candidates, PFA offers the safest option. For longstanding persistent or permanent AF, surgical ablation may be a better option in some cases.
One more thing to keep in mind is that, while it’s not always possible to prevent AF, you can reduce your risk by making healthy lifestyle choices.
“We know that regular exercise, quitting alcohol and treating hypertension, diabetes and obstructive sleep apnea are important. We want to take a holistic approach in managing AF and treating the patient as a whole,” said Dr. Al Chekakie.
To learn more about heart care at AdventHealth Cardiovascular Institute, visit HeartCareKC.com.
