Scott Webb (Host): Atrial fibrillation or AFib is a fairly common heart rhythm condition that typically affects older patients. And today, we're going to learn more about AFib and a new approach to treating it called pulsed field ablation or PFA. Dr. Meet Patel is here. He's a cardiologist specializing in cardiac electrophysiology with Summa Health. 

This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Doctor, it's nice to have you on today. We're going to talk about atrial fibrillation. We'll probably abbreviate it as AFib along the way, just because it's easier to say. So, let's start there. What is AFib?

Dr. Meet Patel: Atrial fibrillation is an irregular heartbeat. There's many things that can cause irregular heartbeat, but it is the most common cause of irregular heart rhythm. And atrial fibrillation is basically an electrical storm happening in the top chambers of the heart, which are called the atria, and it causes them to be unable to squeeze. And so, basically, the top chambers of the heart end up not squeezing. And this is an issue because blood can kind of pool up in those top chambers. And anytime blood sits anywhere or pools anywhere, it could clot. And if a clot were to leave that chamber and go out to the brain, you know, that can lead to a stroke. So, that's why atrial fibrillation is a serious condition, you know, that's why we're worried about it.

Host: Yeah. I have the good fortune of speaking with a lot of heart doctors. And so, I've heard this, that there's electrical issues, there's plumbing issues. So, AFib is more of an electrical issue, if you will. And just wondering, like, who does it affect and how common is it? It feels pretty common, but from an expert, how common is AFib?

Dr. Meet Patel: Atrial fibrillation is relatively common. It's estimated right now in the United States, there's somewhere between three to six million people that have atrial fibrillation. So, I would say that's fairly common. It tends to be more common in older individuals. Usually, you'll see atrial fibrillation more after people turn 60 years old. But, you know, in my practice, even today, I saw somebody who was in their 30s that had atrial fibrillation.

Host: Yeah, it's interesting, you know, and I'm hearing this more and more from experts that things that you could sort of put off, if you will, in your mind. You know, after the age of 55 or after the age of 60, but I hear more and more things like AFib affecting younger people. Do we have any sense of why that is?

Dr. Meet Patel: I think it's always affected younger people, but I think with the dawn of wearable devices like the Apple Watch that now have the ability to detect atrial fibrillation, I think we're starting to detect it early and earlier in life. Atrial fibrillation can come and go. By the time that people were diagnosed in the past, it was because they were having really frequent episodes of atrial fibrillation.

But in my experience, atrial fibrillation gets worse and worse over time. So, you know, sometimes someone may have had an atrial fibrillation that lasted for an hour or so, and it only happened once a year or something like that. But then over time, it becomes more frequent and lasts longer and longer. So now, with Apple Watches and these wearable devices, I think we're starting to just pick up these short asymptomatic episodes of atrial fibrillation at younger ages.

Host: That's an interesting point that it may be that folks in their 30s, you know, were always suffering, as you say, these asymptomatic episodes of AFib, but they didn't have Apple watches to diagnose it. And so, there was no reason for them to go into the office. It's just one of those things in the past. Definitely some good food for thought for sure. Let's talk about treatment options, and let's start maybe with the more traditional methods of treatment.

Dr. Meet Patel: There's a few cornerstones of treatment, but the first and foremost thing is lifestyle modification. You know, anybody with atrial fibrillation, we want to make sure that they're eating right, they're exercising. Weight loss is a big one. You know, people who are overweight, they've shown that if you lose weight, you can actually decrease episodes of atrial fibrillation.

And then, one of the other really big lifestyle modification is diagnosing and treating sleep apnea. Sleep apnea is very, very much linked to atrial fibrillation. And when we identify sleep apnea and we treat it appropriately, you also tend to decrease episodes and severity of atrial fibrillation.

And then after that, you know, depending on how much atrial fibrillation people are having, we can start talking about things like medications versus a procedure called an atrial fibrillation ablation.

Host: Yeah, you mentioned ablation there, and I wanted to focus in on that a little bit, put my notes together here. I came across pulsed field ablation, PFA, and want to compare and contrast maybe a little bit to the sort of gold standard we've had previously, and how they're similar, different, and maybe how you're making some headway with AFib with PFA.

Dr. Meet Patel: We can start with the traditional way of atrial fibrillation ablation. So in the past, you know, we've had two major ways to do an atrial fibrillation operation. We use either heat or we use cold, so we would burn or freeze. And the things that we would burn or freeze are specifically the pulmonary veins. These are veins that return blood from the lungs to the heart. But there's electrical signals that fire off in the walls of these veins, they travel through the walls of the vein into the wall of the atrium and trigger the atrial fibrillation.

So, what we're trying to do is try to prevent those abnormal signals from getting into the heart and starting AFib. So like I said, we would either burn or we would freeze the rim of that vein where it connects to the heart in hopes of killing the cells on that rim and then your body, healing that area with a line of scar tissue where the electrical signals can't pass through the scar and trigger the AFib.

It was pretty effective. The only issue with freezing or burning that tissue is that it's non-selective, meaning that the other tissue around that area could also get affected. And specifically, we would be worried about different nerves. And the scariest part would be the esophagus, where if you were to accidentally burn through the esophagus, you could create a connection or a hole in the esophagus, which is very, very dangerous.

As of last year, there's been a new type of ablation technology available called pulse field ablation. And what that is, is we use an electrical current or electrical field across the cell, which will kill the cells as opposed to having to burn or freeze them. And what's really nice about this, this modality, is that it's very specific to killing only the cells that we want to kill. So, we don't have to worry about damaging nerves or damaging the esophagus or any other tissue around there. The other advantage is it's much faster, whereas an ablation in the past could take between two to four hours. These newer ablations take 45 minutes to an hour, so it's significantly faster and significantly safer.

Host: Yeah. Yeah. I'm hearing that more and more, doctor, with advances in science and technology and medicine, things are just sort of faster, you know, which is great for patients. I'm sure that leads to faster recovery. And I do want to ask you about that, but also just more targeted, you know, more targeted therapies, that kind of thing, whether it's radiation or in this case, PFA, is that your experience? It's just making things easier on, you know, both the providers and patients that you can really target you're trying to treat.

Dr. Meet Patel: Yeah, definitely. I mean, honestly, before, when I was doing ablation, in the back of your mind, you're always, always worried about damaging or hurting something that you're not trying to even affect. With this new technology, that fear is almost gone. And the speed we can help more people, because we can do more of these procedures in a day. And it's almost where it's becoming first-line therapy now for atrial fibrillation.

Host: Yeah, I love hearing that. You know, when we're just talking about AFib again, which is so common, what has been the gold standard, you know, is evolving. And as you're saying, PFA is becoming first line treatment, perhaps now the gold standard. How about the recovery process? How long does it take folks to get back on their feet and back to doing things that they enjoy, whether it's pickleball or whatever it might be?

Dr. Meet Patel: What's nice about atrial fibrillation ablation is that it's not a big procedure. It does sound a little bit scary, but the way we do the procedure is we're not cutting you open. It's not a surgery. We're going through a large vein in the leg. So, we're putting these large IVs into the vein, and that's it. And then, we're able to feed our catheters up through there. So when we're done, all we need to do is pull those catheters and IVs out, and then we just hold pressure. Most of the time, patients can't even find those areas that we went in.

As far as the heart goes, we're not doing significant heart surgery or anything like that, so your heart doesn't really need a lot of time to recover. The recovery period is more about where we put those large IVs in the vein and the leg. And we don't want you to bleed from there. So usually, we say, for about a week, no heavy lifting, don't overexert yourself. But after that week, you're good to go, you can do whatever you want.

Host: Yeah, it's amazing. You know, you mentioned that it's becoming, if it's not already becoming, the first line treatment or the gold standard, if you will. So, let's talk about outcomes, you know, patient success stories maybe, but what's been your experience so far?

Dr. Meet Patel: So, the outcomes, the one thing I want to do emphasize is that PFA is not better than traditional radiofrequency, which is the burning or cryoablation, which is the freezing. The outcomes are exactly the same as far as success rates, you know, if you have atrial fibrillation after one ablation, the chance of you not having AFib again is around 70% to 75%.

Sometimes, we want to get that scar around the vein. You know, just like when you get cut or something, you don't always develop a scar. So, sometimes you might get scar around most of the vein, but there's a little gap where the tissue heals back to normal. So, sometimes we go back in and do kind of a touch up ablation procedure, and then you look closer to 80% success rate. And those are the same numbers that we used to see with the burning or freezing. So although it's not better per se, it's safer and faster, which I think is the advantage of this therapy.

Host: Well, that's perfect. I appreciate your time today. It's nice to talk about AFib. And as you say, new frontline treatment, new gold standard, PFA, better, faster, well, maybe not better, but certainly faster, safer, which brings a smile to my face, certainly as a prospective patient anyway. So, thank you so much for your time.

Dr. Meet Patel: All right. I appreciate it. Thank you.  

Host: And to learn more, go to summahealth.org/heart. And if you enjoyed this episode of Healthy Vitals, we'd love it if you'd leave us a review. Your review helps others find our educational content. I'm Scott Webb. Thanks for listening, and we'll talk again next time.