Atrial fibrillation (AF), which affects about 1% of Hong Kong’s population and about 70,000 people, is the most common heart rhythm problem, and patients are most worried about disease-induced stroke. Traditionally, patients are treated with pulmonary vein obstruction (commonly known as ablation) to prevent recurrence of atrial fibrillation. However, such surgery may have rare complications and the operation time is longer. The new technology “Pulsed Field Ablation” (PFA) recently introduced in Hong Kong not only greatly reduces the risk of complications, but also reduces the operation time by more than half. It is a new option for the treatment of atrial fibrillation.
Patients with atrial fibrillation suffer from two major risks: stroke and heart failure. Due to the irregular heartbeat of patients with atrial fibrillation, the blood flow in the atrium slows down, and blood clots are easy to form. If the blood clot reaches the cerebral blood vessels, it is easy to block them and cause a stroke. Some patients with atrial fibrillation have acute stroke as soon as their symptoms appear. In addition, the fast and slow heartbeat causes some patients to suffer from palpitations, leading to heart failure, shortness of breath, and difficulty in going up stairs or even in daily life.
Medication Refractory disease
Old age is a high-risk factor for atrial fibrillation. About 5% to 8% of people over the age of 70 suffer from atrial fibrillation, and 10% of people over the age of 80 suffer from atrial fibrillation. 40 years old, so the severity and coverage of atrial fibrillation cannot be ignored. In addition to age, high blood pressure, thyroid or heart valve problems, etc., may also cause atrial fibrillation.
Drug treatment is mainly to control heart rhythm and prevent stroke. Some patients take antiarrhythmic drugs to reduce the frequency of atrial fibrillation attacks. The other is an anticoagulant (blood thinner), which prevents strokes. However, drugs cannot cure the disease. As for surgical treatment, pulmonary vein obstruction is traditionally used to ablate the abnormal cells located at the junction of the atrium and pulmonary veins, which emit pulses to harass the atrium and cause atrial fibrillation.
Conventional ablation with risk of complications
Although pulmonary vein blockade can reduce the chance of recurrence of AF, it has certain limitations. It may spread to other body tissues and cause rare complications, such as atrial esophageal fistula (AEF), which creates an abnormal passage between the atrium and esophagus, The narrowing of the pulmonary veins may damage a nerve line in the right diaphragm, affecting breathing. Moreover, the operation time is relatively long, and it will take 2 to 3 hours at the fastest to complete.
Pulsed field ablation, which has just been introduced in Hong Kong, is expected to break through the limitations of complications and operation time. Pulsed field ablation produces energy by outputting a series of high-voltage electric currents that last for several seconds, causing abnormal cells that cause atrial fibrillation, destroying the cell membrane and producing a large number of tiny holes, thereby ablating them. Since the energy critical point (Threshold) of abnormal cells is different from that of esophageal cells and nerve cells, as long as a specific voltage and time are issued to abnormal cells to generate the corresponding critical point energy, it can hit them with one blow. Apoptosis without affecting peripheral cells such as the esophagus and nerve cords, theoretically avoiding complications. Moreover, the operation time of pulsed field ablation only takes more than one hour, which is more than half that of traditional ablation.
Pulsed Field Precisely Destroys Problem Cells
As for pulsed field ablation, the rate of avoiding patient recurrence is close to that of traditional ablation. One year after surgery, more than 80% of patients with intermittent atrial fibrillation and about 70% of patients with persistent atrial fibrillation have no recurrence.
Ms. Lin (pseudonym), a patient with atrial fibrillation in her 70s, suffers from high blood pressure and diabetes. She has taken more than three antiarrhythmic drugs, but her condition cannot be controlled. On average, she will have attacks every one to two weeks, and her heartbeat will be extremely fast for a long time , can only stay at home when sick.
Ms. Lin was worried about the risk of complications in traditional ablation and hesitated about the operation. After learning that the introduction of pulsed field ablation would greatly reduce the risk of complications, I decided to try the new technology. After receiving the treatment, the arrhythmia that plagued her every week has not recurred, and she does not need to take anti-arrhythmic drugs. Three months after the operation, her atrial fibrillation has not recurred.
There are many different treatment options for atrial fibrillation, each with different effects and side effects. If patients have any doubts, they should consult their attending physicians.
Hong Kong Adventist Hospital – Stubbs Road
Cardiologist Dr Fung Wing Hong
2023-08-13 17:29:08
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