New Technology: Pulsed Field Ablation for Atrial Fibrillation (video/podcast)

Atrial fibrillation happens when the heart beats at a very fast rate — typically more than 100 beats per minute. Commonly called AFib, atrial fibrillation is the most common form of arrhythmia, or irregular heartbeat. AFib causes various symptoms and can be very serious.

New technology can treat AFib using faster, more effective methods than in the past. In this video, San Diego Health host Susan Taylor talks with Douglas Gibson, MD, a cardiac electrophysiologist at Scripps Clinic Anderson Medical Pavilion in La Jolla and director of cardiac electrophysiology at Prebys Cardiovascular Institute.

AFib affects the atrium, or upper left chamber of the heart muscle, and sends out electrical signals that are much faster than normal. It can be caused by various factors.

Genetics is one of the major causes of AFib, but high blood pressure, obstructive sleep apnea, valvular heart disease and other conditions also may contribute. It typically occurs in patients age 75 and older, but it is becoming more common among younger people as well.

Symptoms of AFib include heart palpitations, shortness of breath and lightheadedness. Some patients may feel their heart racing even while they are just reading, watching television or resting. Others may not notice it.

Moreover, AFib symptoms are not constant; they come and go.

“There’s a long list of things that kick it into high gear and cause the heart muscle to spit out these rapid electrical signals, things like stress, dehydration, lack of sleep and alcohol,” says Dr. Gibson. “There’s a syndrome called holiday heart. We’ll have a rash of visits to the ER over the holiday season because of excess alcohol use.”

The symptoms can be uncomfortable, but more importantly, AFib increases the risk of stroke. That’s why treatment is so important.

Medications are the first line of therapy in atrial fibrillation treatment. If they are not effective or have unpleasant side effects, surgical interventional procedures can use blood thinners to reduce stroke risk.

If these treatments aren’t successful, the usual next step is to eliminate the abnormal heart muscle that causes the arrhythmia. This process is known as ablation.

“Historically, we’ve used thermal energy to heat up and destroy the abnormal heart muscle, but we now have a new way to ablate it,” says Dr. Gibson. “We deliver pulses of energy at the abnormal heart muscle, and it is a unique treatment that’s much safer and more effective.”

Pulsed energy ablation is an outpatient procedure performed while the patient is sedated. A long, thin tube called a catheter is threaded through a small incision in the groin up to the heart, and the energy is delivered through the catheter to the abnormal muscle. This very minimally invasive procedure takes less than an hour.

“That’s one of the advantages of the new therapy. It’s much quicker, safer, more effective, but phenomenally shorter,” explains Dr. Gibson. “Most of our patients are going home the same day. We keep them for about four hours, make sure they’re fine, and then they can go home — although we’re happy to keep patients overnight if they want to stay.”

Patients can be completely functional around the house as soon as the same evening. Three or four days later, they may take short walks outdoors, and resume exercising on day five. By day 10, says Dr. Gibson, they can do anything they were doing prior to the ablation.

Who is a good candidate for pulsed energy ablation? In general, patients should be highly symptomatic to the point where their AFib is bothering them to a reasonable degree in their everyday lives. Patients whose symptoms are mild, who are much older or frail, or who are pregnant would likely not be considered for this procedure.

For those who do qualify, pulsed energy ablation is a major treatment breakthrough.

“This is a once-in-a-career revolutionary therapy change for ablation and Scripps was at the forefront of it,” says Dr. Gibson.

“We did basic research studies that led to the FDA approval. We’re super excited to finally be able to use it in our patients who are suffering from AFib.”

Scripps was the only regional site to participate in the pivotal clinical trial that led to FDA approval of Farapulse pulsed field ablation system. Dr. Gibson was the lead investigator and the first physician in San Diego County to perform the procedure.

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