One is a retired high school teacher from Leesport. Another is an insurance professional and mother of two from Harrisburg. The third is a retired dentist who lives near State College.
They’ve never met but share common bonds. All suffer from atrial fibrillation, or AFib, which is caused by an irregular and often rapid heartbeat in the upper chambers of the heart. It is the most common heart rhythm disorder in adults in the United States.
This summer, the trio were among the first patients to undergo a newly approved heart ablation procedure at Penn State Health hospitals.
Now, all three are feeling more energetic with fewer, if any, episodes of atrial fibrillation since having a pulsed field ablation (PFA).
“Before, I was so exhausted. I would just sleep and not want to walk or exercise or anything. And I’m a ‘go’ person. I go all the time,” said Krissy Baker, a 48-year-old insurance claims manager who had the PFA procedure in July at Penn State Health Holy Spirit Medical Center in Camp Hill. “Now, I’m pretty much back to the energy I used to have.”
Traditionally, cardiac ablation, a procedure used to create small scars in the tissue to block faulty signals in the heart, has used either cold (cryoablation) or heat (radiofrequency) energy techniques.
Although thermal ablations are still utilized, new PFA technology was approved by the U.S. Food and Drug Administration in January. The FARAPULSE system (Boston Scientific) uses PFA and is now available at Holy Spirit Medical Center, Penn State Health Milton S. Hershey Medical Center and Penn State Health St. Joseph Medical Center.
“We have been performing this procedure since June, soon after it became commercially available,” said Dr. Sarah Hussain, an electrophysiologist at Penn State Heart and Vascular Institute and associate professor of medicine at Penn State College of Medicine. “We have done over 100 PFA procedures across the Penn State Health system.”
Pulsed field ablation, which uses short bursts of electrical energy to target cardiac tissue, gives doctors another option to treat atrial fibrillation, according to Hussain.
“We try and individualize our therapies to each patient,” Hussain said. “It’s important to continue to expand our toolkit of treatment options for AFib. Certain therapies work differently for different patients.”
From secret excuses to Great Dane walks
Busy working full-time and raising two teenagers, Baker began having heart issues a few years ago. Diagnosed with a low, resting heartbeat, or bradycardia, she had a pacemaker inserted. She also dealt with intermittent AFib, experiencing what felt like a hot pinprick that traveled in a line from the bottom of the right side of her heart, diagonally, to the top left.
“Sometimes it would be a little more intense than others, and those times I’d feel like I needed to go to the hospital,” Baker said. “Sometimes the AFib sensations wouldn’t let up right away. Sometimes they would.”
Baker was at a friend’s house last Easter when her group decided to go for a walk after dinner. She secretly was dealing with a prolonged AFib episode, so she made excuses about not having sneakers and not feeling well because she was afraid of what would happen if she joined the walk. Her heart condition continually affected her quality of life.
Within three months, Baker received a pulsed field ablation. Initially, she still didn’t feel much better and experienced at least one significant AFib event post-procedure. Gradually, her energy increased. She’s now walking 10,000 or more steps a day, including a daily lunchtime stroll with her Great Dane. She hasn’t had an AFib episode since mid-August.
The goal of AFib ablations is to improve quality of life and allow patients to return to their previous activity level without experiencing future episodes or experiencing ones which are shorter and more infrequent than before, said Dr. Jamal Hajjari, the electrophysiologist who performed Baker’s ablation using the PFA technique at Holy Spirit Medical Center. In some patients, it may require more than one ablation to reduce the burden of atrial fibrillation, he said.
Fewer complications
Hajjari said clinical evidence shows the PFA technique has roughly the same efficacy as thermal ablation methods used on patients with intermittent AFib. The reported success is greater than 70% with a single ablation. The procedure takes about the same amount of time using each technique, but PFA has improved the overall efficiency of AFib ablations.
The primary advantage PFA has over the other techniques, Hajjari said, is that it is less likely to cause collateral damage to areas around the heart. The percentage of major complications after ablations is less than 2%, he noted, and the risk of collateral damage to the phrenic nerve, which controls the diaphragm, or the esophagus from thermal ablations is below 1%.