How Ablation Is Improving AFib Treatment and Patient Outcomes

Atrial fibrillation (AFib) is the most common heart rhythm problem in the world. The American Medical Association predicts that, by 2030, more than 12 million Americans will have AFib, putting them at risk of stroke or heart failure.

There’s nothing new about the condition — the danger of an irregular heartbeat was described 2,500 years ago by Hippocrates. What is new, and rapidly advancing in recent years, is the array of tools that doctors have to treat AFib.

Some of the greatest progress has been in the use of ablation, a minimally invasive procedure that deadens the parts of the heart tissue that are triggering abnormal rhythms. The newest innovation, pulsed field ablation, accomplishes this with small electrical fields that cause selective cardiac cell injury.

Coupled with other advances, ablation increasingly is used earlier after diagnosis.

“The safety and efficacy of this procedure have just skyrocketed over the years,” said Alexander Turin, MD, a clinical cardiac electrophysiologist with Trinity Health Medical Group, Cardiology – Muskegon. “This is a wonderful field to be in because we constantly get new approaches and tools that make these procedures faster, better, and safer.”

Ablation as an Earlier Treatment Option

For decades, the first intervention considered for treating heart rhythm disorders was medication to slow the heart rate. That started to change about 30 years ago, Dr. Turin said. Today ablation is considered the first option. And now it is being used sooner.

“An emerging concept that came out of a trial a few years ago showed intervention with ablation for AFib within the first year of diagnosis actually resulted in better outcomes,” Dr. Turin said.

“That opened the door a little bit to trying to identify patients sooner,” he said. “We always appreciated this, but for the first time it was really demonstrated that early intervention actually makes a difference.”

One possible reason is that the longer AFib persists, the more damage it can cause to the heart, which can lead to more AFib.

“AFib begets AFib,” Dr. Turin said. “The more of it you have, the more of it you will have.”

The limited data suggests that earlier intervention through ablation can result in better efficacy, possibly by limiting the ongoing damage.

With Age Comes Risk

It’s difficult to pinpoint a single cause of AFib, Dr. Turin said. Risks include heart disease; tobacco, marijuana and alcohol use; sleep apnea, diabetes and high blood pressure. In rare cases there are genetic causes. And although heart rhythm problems can occur at any age, the risk of AFib increases as patients get older.

“Without a clear causal relationship, it’s almost exclusively a disease that affects people in their sixth and seventh decades,” he said. “When people ask, ‘Why did I get AFib?’ the answer is because you’ve lived long enough.”

AFib is sometimes asymptomatic and it is not considered curable over the long term, so cardiac electrophysiologists like Dr. Turin focus on “burden” — the percentage of time the patient’s heart is out of rhythm. Treatments are designed to keep that percentage low.

“When we talk about AFib, we’re really focused on symptoms,” he said. “Symptomatic AFib is very simple. If it bothers you, you should treat it.”

What to Watch For

Symptoms of AFib vary, but can include:

• Racing or fluttering heartbeat
• Shortness of breath
• Fatigue
• Dizziness or lightheadedness
• Chest discomfort

Red flag symptoms include fainting or near-fainting, trouble breathing, chest pain, and swelling in the legs.

This is important because the disorganized rhythms of AFib leave the heart unable to pump out enough blood. And when blood is not moving, it tends to clot. Those clots can eventually reach the brain, leading to stroke.

The American Heart Association says AFib can double the risk of death and is linked with a fivefold increased risk of stroke. AFib also can contribute to heart failure by overworking the heart muscle.

What to Expect With an Ablation

The first step to the procedure is preparation, Dr. Turin said. This includes starting or continuing a blood thinner for a few weeks. One or two days before the procedure, doctors will check the anatomy of the heart, either with an ultrasound under anesthesia or with a specialized computerized tomography (CT) scan, to identify any abnormal structures that might complicate the ablation.

The day of the procedure, patients will have the groin and chest areas shaved, then they will be moved to the procedure room and be put under sedation.

Using an IV in the groin, doctors will insert a catheter — a tube with different tools on the end — to enter a blood vessel and follow that to the upper heart chambers. After some testing and imaging, doctors target the appropriate areas for ablation.

Historically this was done with thermal energy. (Cooling energy called cryo is another option, Dr. Turin said, although that now is used less frequently.) The newest tool in the toolbox, pulsed-field ablation, is specific to heart cells and uses high voltage electric fields to disrupt cell membranes. The choice of method depends on what the cardiac electrophysiologist needs to accomplish.

After some testing, everything is removed and the incision in the groin is closed. Depending on the patient and extent of the procedure, some stay overnight but many go home the same day.

“When patients go home, they can walk that day,” Dr. Turin said. “We generally recommend against any kind of meaningful exertion or heavy lifting, but they can get back to day-to-day life. People who have desk jobs could go back to work as early as the next day if they really wanted to.”

Continuing Advances

Trinity Health Michigan is well-equipped to handle all types of AFib and continues to take advantage of new technologies and procedures in the rapidly advancing field. Our AFib specialists offer clear guidance and can help you get back to living confidently. 

“I'm actually blown away a little bit myself in that I finished my training three years ago, and half of what I do is not something I trained on, which is to say the technology has advanced that quickly,” Dr. Turin said.

“Our job is to continue to provide high-quality services. We’ve done a wonderful job at improving access over the last few years and staying contemporary in terms of our equipment and approach.”

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