New technology at UVA Health offers safer treatment for atrial fibrillation – CBS 19 News

The Silent Epidemic: Understanding Atrial Fibrillation and Its Dangers

The human heart, a marvel of biological engineering, typically beats with a steady, reliable rhythm, pumping life-sustaining blood throughout the body over three billion times in an average lifespan. But for millions of Americans, this dependable rhythm is disrupted by a condition known as Atrial Fibrillation, or AFib. This common heart arrhythmia, characterized by a rapid and irregular heartbeat, is more than just an inconvenience; it is a serious medical condition that significantly increases the risk of stroke, heart failure, and other cardiovascular complications. Now, a pioneering advancement at UVA Health is set to redefine the treatment landscape for this pervasive ailment, offering patients a safer and more effective path back to a steady rhythm.

Atrial Fibrillation occurs when the heart’s two upper chambers, the atria, beat chaotically and out of sync with the two lower chambers, the ventricles. Instead of a strong, coordinated contraction, the atria quiver, or “fibrillate.” This chaotic electrical activity can lead to a range of debilitating symptoms, including heart palpitations, shortness of breath, extreme fatigue, and dizziness. For some, however, AFib is asymptomatic, a silent threat that may only be discovered after a major health event, like a stroke.

The primary danger of AFib lies in its propensity to cause blood clots. The irregular quivering of the atria allows blood to pool and stagnate, creating an ideal environment for clots to form. If a piece of a clot breaks off, it can travel through the bloodstream to the brain, blocking blood flow and causing a devastating ischemic stroke. In fact, individuals with AFib are approximately five times more likely to suffer a stroke than those with a regular heart rhythm. This stark reality underscores the critical importance of effective and timely treatment.

The prevalence of AFib is on the rise, driven by an aging population and an increase in risk factors such as hypertension, obesity, diabetes, and sleep apnea. It is currently the most common cardiac arrhythmia diagnosed in clinical practice, affecting an estimated 6 million people in the United States alone—a figure projected to double by 2030. This growing public health challenge has spurred relentless innovation in the field of cardiac electrophysiology, the subspecialty dedicated to the heart’s electrical system, with researchers and clinicians constantly seeking safer and more durable solutions.

The Evolution of Treatment: A Look at Conventional AFib Therapies

For decades, the approach to managing Atrial Fibrillation has followed a well-established pathway, progressing from medication to more invasive procedures. While these methods have helped countless patients, they each come with a unique set of limitations and potential risks, highlighting the need for the kind of technological leap now being implemented at UVA Health.

Medication Management: The First Line of Defense

The initial step in treating AFib typically involves a multi-pronged pharmacological strategy. Physicians prescribe medications to control the heart’s rate (rate control) and, in some cases, to restore a normal rhythm (rhythm control). Beta-blockers and calcium channel blockers are commonly used to slow down a racing heart, alleviating symptoms and improving cardiac function. Antiarrhythmic drugs may be used to convert the heart back to a normal sinus rhythm and maintain it.

Crucially, most AFib patients require anticoagulants, or blood thinners, to mitigate the high risk of stroke. While highly effective, these medications carry a significant trade-off: an increased risk of bleeding. This requires careful and continuous monitoring, creating a delicate balancing act for both patient and physician. Furthermore, antiarrhythmic drugs can have significant side effects and lose their effectiveness over time, prompting the need for more definitive treatment.

Catheter Ablation: The Gold Standard and Its Challenges

When medication fails to adequately control symptoms or is not well-tolerated, the standard of care often shifts to catheter ablation. This minimally invasive procedure has been the cornerstone of interventional AFib treatment for over two decades. During an ablation, an electrophysiologist threads thin, flexible catheters through blood vessels in the groin up to the heart. The goal is to identify the source of the erratic electrical signals—most commonly found around the pulmonary veins—and create small, precise scars to block them.

Traditionally, this scar tissue has been created using two primary energy sources:

• Radiofrequency (RF) Ablation: This method uses heat. The tip of the ablation catheter delivers radiofrequency energy, heating the targeted cardiac tissue to around 50-60 degrees Celsius to create a lesion. This is a meticulous, point-by-point process that requires great skill and time to create a continuous line of scars.
• Cryoablation: This approach uses extreme cold. A specialized “cryoballoon” is inflated at the opening of a pulmonary vein, and a refrigerant is used to freeze and destroy the problematic tissue in a single application.

While both RF and cryoablation have proven highly effective for many patients, they are not without significant risks. The use of thermal energy—whether hot or cold—is indiscriminate. The energy can spread beyond the intended heart muscle, potentially damaging critical adjacent structures. One of the most feared, though rare, complications is an atrio-esophageal fistula, a life-threatening injury to the esophagus, which lies directly behind the left atrium. Another risk is damage to the phrenic nerve, which controls the diaphragm, potentially leading to breathing difficulties. Finally, excessive thermal energy can cause a narrowing of the pulmonary veins, known as pulmonary vein stenosis. These potential “collateral damage” scenarios have long been the Achilles’ heel of thermal ablation, a constant concern for physicians aiming for both efficacy and utmost safety.

A New Dawn in Cardiac Care: UVA Health Introduces a Groundbreaking Technology

Recognizing the limitations of existing therapies, UVA Health has become one of the select centers in the nation to adopt a revolutionary new approach to catheter ablation: Pulsed Field Ablation (PFA). This cutting-edge technology represents one of the most significant advancements in electrophysiology in a generation, promising a level of safety and precision previously unattainable and directly addressing the core risks associated with thermal ablation methods.

How Pulsed Field Ablation Works: Precision Without the Heat

Unlike RF and cryoablation, PFA is a non-thermal energy source. Instead of burning or freezing tissue, the PFA system delivers a series of very short, high-voltage electrical pulses to the targeted heart muscle. These microsecond-long pulses create tiny, permanent pores in the cell membranes of the heart muscle cells, a process called irreversible electroporation. This disruption triggers a natural, programmed cell death (apoptosis) specifically in the targeted cells, which are then replaced by scar tissue over time, effectively blocking the faulty electrical pathways causing AFib.

The entire process occurs without generating significant heat or cold. The temperature of the surrounding tissue remains stable, eliminating the risk of thermal injury that has shadowed conventional ablation procedures for years. It’s a fundamental paradigm shift—from a destructive, brute-force thermal method to a sophisticated, bio-electric approach that harnesses cellular biology to achieve its goal.

The Key Advantage: Unprecedented Tissue Specificity

The true genius of Pulsed Field Ablation lies in its remarkable tissue specificity. Different types of cells in the body have different thresholds for electroporation. Cardiac muscle cells (myocytes) are uniquely susceptible to this form of energy, while other tissues—such as the smooth muscle of the esophagus and blood vessels, or the delicate nerve tissue of the phrenic nerve—are far more resilient.

This differential sensitivity is the technology’s built-in safety mechanism. The PFA system is calibrated to deliver an energy field strong enough to ablate the heart muscle but below the threshold required to damage the surrounding, non-cardiac structures. This myocardial-selective nature virtually eliminates the risk of collateral damage to the esophagus, phrenic nerve, and pulmonary veins. For physicians at UVA Health, this means they can deliver effective, durable lesions with a level of confidence and safety that was previously impossible. It transforms the risk-benefit calculation of an ablation procedure, making it a much more compelling option for a broader range of patients.

Transforming the Patient Experience: What This Means for Virginians

The adoption of PFA technology at UVA Health translates into a cascade of tangible benefits for patients across the Commonwealth and beyond:

• Enhanced Safety Profile: The most significant benefit is the dramatic reduction in the risk of major complications. Patients can undergo the procedure with greater peace of mind, knowing that the most serious potential injuries associated with ablation are largely mitigated.
• Increased Efficiency and Shorter Procedures: PFA catheters are often designed to deliver energy over a wider area than traditional point-by-point RF catheters. This allows electrophysiologists to create the necessary lesions far more quickly, significantly reducing overall procedure time. Shorter procedures mean less time under anesthesia and a lower risk of anesthesia-related complications.
• Potentially Higher Efficacy: The rapid and predictable nature of PFA energy delivery may lead to more durable and contiguous lesions, which is critical for the long-term success of the ablation. While long-term data is still being gathered, early results suggest excellent freedom from AFib recurrence.
• Faster Recovery: With less ancillary inflammation and tissue disruption, patients may experience a smoother and quicker recovery period, allowing them to return to their normal lives sooner.

The Patient Journey: Navigating AFib Treatment with Advanced Technology

For a patient diagnosed with persistent or symptomatic AFib, the availability of PFA at UVA Health fundamentally alters their treatment journey. It begins with a comprehensive consultation at UVA’s state-of-the-art Heart and Vascular Center. Here, a team of expert electrophysiologists, nurses, and technicians evaluates the patient’s specific condition, discusses all available options, and determines if they are a candidate for the new procedure.

On the day of the procedure, the patient is brought to a specialized electrophysiology (EP) lab. Under sedation or general anesthesia, the medical team uses advanced 3D cardiac mapping systems to create a detailed, real-time anatomical and electrical model of the patient’s heart. This “GPS for the heart” allows the physician to navigate the PFA catheter with millimeter precision.

Once the target areas around the pulmonary veins are identified, the physician positions the catheter and delivers the pulsed field energy. Unlike the lengthy and meticulous process of RF ablation, the energy delivery with PFA is remarkably swift—often taking just a few seconds per application. The team can confirm in real-time that the targeted tissue has been successfully isolated without affecting nearby structures. The entire procedure, from start to finish, can be completed in a fraction of the time required for a traditional thermal ablation.

Post-procedure, patients are monitored closely before being discharged, often the next day. The recovery is typically swift, and the long-term management plan will include follow-up appointments to monitor the heart’s rhythm and overall health. For many, the result is a life free from the burdensome symptoms of AFib and, most importantly, a dramatically reduced risk of stroke.

Expert Analysis: The Broader Implications for Electrophysiology

The implementation of Pulsed Field Ablation at UVA Health is not merely an incremental upgrade; it is a disruptive innovation that signals a new chapter in the treatment of cardiac arrhythmias. This move places the institution at the forefront of cardiovascular care, reflecting a commitment to patient safety and superior outcomes.

Raising the Bar for Safety and Efficacy

For years, the electrophysiology community has grappled with the inherent trade-off between procedural efficacy and safety. To create durable lesions that prevent AFib recurrence, physicians needed to apply enough energy, but doing so increased the risk of collateral damage. PFA effectively breaks this paradigm. It allows for the aggressive and confident application of energy to achieve durable pulmonary vein isolation while simultaneously building in a layer of safety that protects surrounding tissues.

This development is expected to democratize the procedure. While complex ablations have traditionally been the domain of highly experienced operators at major academic centers, the comparative simplicity and safety of PFA may lower the barrier to entry, allowing more physicians to offer this life-changing therapy with consistent and safe results. By investing in this technology and the expertise to wield it, UVA Health is not only improving care for its own patients but also helping to set a new, higher standard for the entire field.

The Future of AFib Management

The advent of PFA is likely just the beginning. The technology is rapidly evolving, with new catheter designs and energy delivery algorithms in development. Researchers are exploring its use for other cardiac arrhythmias beyond AFib, potentially opening up safer treatment avenues for a host of other conditions. As long-term data continues to affirm its safety and durability, PFA is poised to become the dominant modality for catheter ablation worldwide.

By being an early adopter, UVA Health positions itself as a leader in this evolution. It becomes a hub for complex cardiac care, attracting patients from across the region seeking the safest and most advanced treatments available. Furthermore, it establishes itself as a center for research and education, helping to train the next generation of electrophysiologists in this game-changing technique.

A Healthier Heartbeat for the Commonwealth

Atrial Fibrillation is a complex and challenging condition that casts a long shadow over the lives of millions. The introduction of Pulsed Field Ablation technology at UVA Health marks a pivotal moment in the fight against this arrhythmia. By prioritizing a treatment that is not only highly effective but also fundamentally safer, UVA is offering new hope to patients who may have been hesitant to undergo a more invasive procedure.

This innovation is more than just a new piece of equipment; it is a testament to a patient-first philosophy, where the pursuit of medical advancement is inextricably linked to the well-being and safety of the individual. As this technology becomes the new standard of care, the residents of Virginia and beyond can be confident that a leading-edge solution to restore the heart’s natural rhythm is now within reach, promising a future with fewer strokes, less medication, and a better quality of life—one steady, healthy heartbeat at a time.