2024-08-20 09:15:51
A new therapy to safely and successfully treat the common type of heart arrhythmia promises to mark a before and after in the treatment of atrial fibrillation.
The therapy, called pulsed field ablation, has received approval from the United States Food and Drug Administration (FDA) and has begun to be used by one of the Mayo Clinic hospitals in the United States.
The irregular and frequent heart rate of atrial fibrillation can cause blood clots in the heart, increasing the risk of stroke. Doctors can use drugs and therapy to help restore a patient’s heart rhythm, but some patients have atrial fibrillation that persists and can worsen.
Laser therapy has been used for about two decades to treat these patients, but a new therapy, called pulsed field ablation, uses a different approach.
Unlike traditional ablation, catheter therapy for pulsed field ablation uses short, high-energy pulses called irreversible electroporation to target the heart muscles that cause atrial fibrillation. Pulsed field therapy was successfully used in patient care at the Mayo Clinic in February 2024. Since then, cardiologists at this institution have used pulsed field therapy to treat more than 200 patients with atrial fibrillation
“Traditional methods that use hot energy sources to treat atrial fibrillation (radiofrequency, laser, cryogenics) have the risk of injury associated with nearby structures such as the esophagus and phrenic nerve,” Dr. Suraj Kapa, a cardiologist at Mayo. Hospital.
Pulsed field ablation technology has been in development for more than 18 years. Mayo Clinic’s pioneering research in ablative therapy began with another electrocardiologist and prolific inventor, Dr. Samuel J. Asirvatham. He has a great interest in developing new techniques that will allow selective cardiac action.
“The basic principle in pulsed field ablation is that, depending on the composition of the cell membranes of different types of tissue, certain tissues can show different energy patterns,” explained Dr. Kapa. “Through hundreds of previous experiments, it has been concluded that pulsed field stimulation of the heart muscle can enable a specific concentration of the heart tissue, avoiding injury to structures such as the esophagus or the phrenic nerve.”
The research led to the development of two systems that were recently approved in the United States. Dr. Kapa noted that both catheters are approved to treat atrial fibrillation in the form of pulmonary artery occlusion and have shown similar efficacy in clinical trials compared to traditional radiofrequency ablation.
Abnormal electrocardiogram activity on monitor. (Credit: Amazing Things/NCYT)
Advantages of pulsed field ablation
Pulsed field stimulation can lead to faster procedures by reducing anesthesia time and eliminating some of the risks of traditional atrial fibrillation ablation.
“Reducing the risk and making the treatments more effective is important to provide therapy to the greatest number of patients,” said Dr. Kapa.
It is estimated that 12.1 million people in the United States will be diagnosed with atrial fibrillation by 2030 – more than double compared to 2010. Worldwide, the number of patients diagnosed with atrial fibrillation is also increasing.
“Growing evidence supports more aggressive rhythm control with ablation, either earlier in the patient’s fibrillation diagnosis to achieve better long-term outcomes or in the context of other diseases, such as heart failure, where ablation is indicated to reduce mortality,” Dr. Kapa argued.
Evaluation such as pulsed field stimulation can be used for other arrhythmias, such as ventricular arrhythmias, in progress. Early predictive data suggest that pulsed field induction may outperform current traditional thermal energy source approaches in this area. (Source: Mayo Clinic)
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