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| SUNDAY, FEBRUARY 16, 2025
Atrial Fibrillation (AFib) is the most common type of
arrhythmia in the United States
(PHOTO COURTESY OF ISTOCK IMAGES)
Patients suffering work together as they are de- rely on thermal energy to to, leading to the lower create extreme temperatures, from atrial fibrillation signed ventricular chambers not pulsed field ablation relies on (AFib) whose doctors filling completely or pumping tissue-selective, non-thermal electric fields to ablate heart recommend ablation as enough blood to your lungs and body. tissue and return the heart to part of their treatment “When a person is in AFib, its normal rhythm. they frequently become Rather than heating or coolnow have another aware of their heart beating tissue to create cell death, choice among the two ing which very often can be this form of energy utilizes types of ablations quite fast, even while at rest. high voltage, rapid electrical Other symptoms can include pulses, which function to currently available. By Keith J. O’Connor
Special To The Republican
Called pulsed field ablation (PFA), Boston Scientific’s FARAPULSE PFA System was approved by the U.S. Food and Drug Administration last year. The approval followed positive 12-month data from the pivotal ADVENT clinical trial – the first randomized clinical trial to directly compare the efficacy and safety of the system against standard-of-care ablation – which found that therapy with the device was as safe and effective as conventional thermal ablation. Baystate Medical Center is one of the few facilities in Massachusetts to offer pulsed field ablation with their electrophysiologist team using the FARAPULSE™ Pulsed Field Ablation System. Atrial fibrillation is the most common type of arrhythmia in the United States. “AFib is due to changes in the electrical signaling that coordinate your heartbeat. During atrial fibrillation, the atria, which are the top chambers of the heart, begin contracting irregularly and fast which causes the heart to quiver or fibrillate,” said electrophysiologist Dr. Marshal Fox of the Baystate Health Heart and Vascular Program. As a result of the irregular heartbeat, the heart’s upper and lower chambers do not
general fatigue, dizziness and lightheadedness, chest pain and shortness of breath. Some people may even have no symptoms,” Dr. Fox said. “It is important to recognize the symptoms and to have regular check-ups with your provider because if left untreated, AFib can lead to stroke, heart failure, heart attack and dementia. If you have AFib, you are five times at greater risk for stroke because blood can pool inside the heart and form a clot which then travels to the brain,” he added. For many, the most effective treatment for AFib is cardiac ablation. Offered in several forms - radiofrequency ablation, cryoablation and the new pulsed field ablation - ablation is a safe, minimally invasive, surgical procedure that alters targeted heart cells to the point of scarring. This helps disrupt the electrical signals causing the irregular heartbeat and works to maintain a normal rhythm. During a traditional ablation procedure, a catheter is inserted into the femoral veins and guided to the interior of the heart and generates extreme temperatures – hot for radiofrequency ablation and cold for cryoablation – to destroy targeted areas associated with abnormal heart rhythms. Different from traditional ablation procedures which
Because this novel form of energy delivery specifically targets cardiac tissue, the risk of damaging surrounding structures, particularly the esophagus, is dramatically reduced. While thermal based ablation is still incredibly safe, pulsed field ablation has taken already rare complications and further reduced the risk of occurrence adding
Dr. Marshal Fox, MD Baystate Health Heart and Vascular Program
Dr. Kyle Gobeil, DO Baystate Health Electrophysiology and Cardiology
(PHOTOS COURTESY OF BAYSTATE HEALTH)
destabilize the cell membrane. This creates micropores within the cell membrane causing the cellular contents to leak from the cell, triggering cell death. The important distinction is that the amount of energy used is specific to cardiac cells. “One of the greatest advantages to pulsed field ablation is the potential to lower the risk of complications.
additional safety to the procedure,” said Dr. Kyle Gobeil, one of three Baystate electrophysiologists trained in the procedure at Baystate. In well over thousands of patients who have undergone pulsed field ablation in the country since its inception, there has not been a single reported case of damage to the esophagus, Dr. Gobeil noted. “So, this new procedure has
taken away what we worry about most as far as risks to our patients. When waking up after the procedure, patients tend to feel better, experiencing less side effects, such as chest discomfort, resulting from inflammation traditionally associated with thermal-based ablation,” he said. One of the many features Boston Scientific identified as part of their promotion of the new procedure was the less time it takes to perform pulsed field ablation allowing doctors to perform more cases per day. “Typical cases take about two hours, often quicker than thermal ablation. This means increased access for our patients to this highly effective procedure,” Dr. Gobeil said. “While the goal is not to see how quickly the ablation can be performed, there is something to be said about the benefits of lesser time under general anesthesia for our patients, as well as lesser time being inside a patient’s heart. So, with pulsed field ablation, a safer and quicker procedure can be performed resulting in a win-win for our patients,” he added, noting most patients go home the same day. Some of the most common causes of AFib include weakening of the heart muscle or cardiomyopathy, coronary artery disease, hypertension and aging. “AFib is primarily a disease that affects older people, one in ten of those above the age of 80,” Dr. Fox said, compared with 1 in 1000 of individuals less than age 55. Recent studies have found that AFib is more common than previously thought. Today the Centers for Disease Control and Prevention (CDC) estimate that 6.1
million adults in the United States have AFib. This number is expected to increase to 12.1 million by 2030. Also, the CDC noted that because the number of AFib cases increases with age and women generally live longer than men, more women than men are experiencing AFib. Dr. Fox agrees that the number of patients seen by their doctor for AFib is growing. One reason is an aging population, but cardiologists are seeing younger patients as well due to unhealthy lifestyles leading to risk factors for AFib such as high blood pressure, diabetes, obesity and coronary artery disease. Yet another reason - the increasing use of wearable tech such as smart watches and mobile EKG monitors which alert the user to an irregular heartbeat. While ablation is the most common treatment for AFib, your healthcare provider may recommend medications such as blood thinners and antiarrhythmic drugs, cardioversion, and in rare cases surgery which is used to fix structural problems that are causing the AFib in patients. “Lifestyle changes such as exercising 30 minutes each day, eating a healthy diet and decreasing your alcohol intake are also important to reduce your risk of developing AFib. If you are obese, losing 10% of your body weight over time will reduce your risk. Obesity is also linked to sleep apnea which is another major risk,” Dr. Fox said.
For more information on AFib and its many treatments available, visit baystatehealth.org.