For several decades, heart rhythm specialists such as St Vincent’s Private Hospital Northside’s A/Prof. Haris Haqqani and Dr Tomos Walters have conducted ablation procedures - a minimally invasive procedure where thermal treatments such as radiofrequency or cryoablation have been used to heat or freeze the abnormally firing tissue in the left atrium that triggers AF episodes.
This causes it to become scar tissue – rendering it electrically inert. However, these procedures can involve the patient being under general anaesthetic for up to two hours.
“It’s been a fairly effective treatment over the years, although rendering all of the tissue inert is quite challenging and you often have to go back and do multiple procedures over a period of time, to get that complete electrical isolation,” says Dr Walters.
“Also, there’s a danger, which is rare, that in making the tissue around the left atrium inert, because of its proximity to other organs and tissue, there’s the potential to damage the oesophagus and nerves that lead to the diaphragm. In the most extreme cases – again which is rare - it can be fatal.”
Dr Tomos Walters
A/Prof Haris Haqqani
Pulsed Field Ablation (PFA), uses high intensity electric fields of around 2000 volts to deliberately injure the heart muscle cells in the same area.
A/Prof. Haqqani said that like conventional thermal ablation, PFA still involves inserting a thin, flexible tube called a catheter which is guided from the patient’s groin to the specific site of the heart where the abnormal electrical activity is occurring.
“This new technology is worth its weight in gold and it’s fair to say it’s quite revolutionary. It is clear that it is safer and more efficient for the patient – which is important given that most of the patients who need this procedure are aged in their 60s, 70s and some in their 80s,” says A/Prof. Haqqani.
“What’s important – especially given the age of the majority of patients - is that we now have the ability to not have the patient under anaesthetic for a significant period and we don’t have to spend over an hour in the left atrium. The actual ablation time with PFA is only around 15 minutes or less. With thermal ablation procedures you typically would only do one or two procedures in a session, but due to the greater efficiency and faster workflow of PFA, many more patients should be able to be treated in that time.
“This will have an enormous positive impact on reducing surgical waiting times, particularly of course in the public system (which has waiting times of around two to three years in some hospitals), but also in the private hospital system.”
