The human heart beats over 1,00,000 times a day, guided by a precise electrical system that ensures every heartbeat is coordinated and efficient. When this electrical network functions normally, the heart pumps blood seamlessly throughout the body. However, when these electrical signals become disorganised, the heart can develop abnormal rhythms known as arrhythmias.
One of the most common and clinically significant arrhythmias is Atrial Fibrillation (AFib), a condition that affects millions worldwide and significantly increases the risk of stroke, heart failure and death if left untreated. Fortunately, advances in the field of cardiac electrophysiology are transforming how we diagnose and treat this condition, with Pulse Field Ablation (PFA) emerging as one of the most exciting breakthroughs in recent years.
Under normal circumstances, the electrical impulse travels in a coordinated pathway through the heart, allowing the chambers to contract in a synchronised manner and pump blood effectively. In Afib, this orderly electrical activity is disrupted. Instead of a single organised electrical signal, multiple abnormal electrical impulses fire simultaneously from different areas within the upper chambers of the heart. As a result, the atria begin to quiver or fibrillate rapidly, sometimes at rates of 350 to 400 beats per minute, leading to an irregular and often rapid heartbeat.
Many patients with AFib experience palpitations, chest discomfort, shortness of breath, fatigue, dizziness and reduced exercise tolerance. In severe cases, patients may present to the emergency department with extremely fast heart rates. Untreated AFib is associated with serious long-term complications. Blood can stagnate within the upper chambers of the heart, increasing the likelihood of clot formation and stroke. Over time, persistent irregular heart rhythms can also weaken the heart muscle, leading to heart failure.
What is cardiac electrophysiology?
Cardiac electrophysiology is a specialised branch of cardiology dedicated to diagnosing and treating disorders of the heart's electrical system - simply put, Electrophysiologists (specialists in electrophysiology) are the “Electricians” of the heart. Cardiac electrophysiologists use a comprehensive approach to the management of complex rhythm disorders such as Afib.
What is comprehensive Afib care?
There are 2 main aspects to Afib management - first is rhythm control so as to restore and preserve normal electrical rhythm, and second is to prevent stroke through use of blood thinners called anticoagulants.
Rhythm control in Afib management refers to restoring and preserving the normal sequence of electrical activation of the heart. Achieving this requires a comprehensive approach including identifying and correcting risk factors for Afib such as hypertension, diabetes mellitus, obesity, sedentary lifestyle, obstructive sleep apnea and quitting alcohol and smoking - all of which comprise Life’s Essential 8 - a terminology coined by the American Heart Association to lower risk of heart disease. In addition to this, most patients also require antiarrhythmic medications and/or catheter-based mapping and ablation to achieve rhythm control.
What is catheter mapping and ablation?
Electrophysiologists use advanced technologies to create 3-dimensional electrical maps of the heart, which enable them to identify abnormal areas responsible for electrical sparking within the heart, giving rise to arrhythmias. This is a minimally invasive procedure performed through a small puncture in the groin. Thin catheters are guided through blood vessels into the heart under imaging guidance. Once identified, one of several energy sources is used to treat these abnormal areas. This prevents abnormal electrical impulses from spreading into the atrium while preserving the heart's normal rhythm.
Radiofrequency ablation – This has long been the main modality for treating abnormal areas within the heart in Afib. However, the longer procedural duration and risk of injury to adjoining tissues have driven the development of newer technologies designed to improve both safety and procedural efficiency.
Pulse Field Ablation - The new kid on the block. Pulse Field Ablation (PFA) represents one of the most significant advances in cardiac electrophysiology in recent years. Unlike radiofrequency ablation, which destroys tissue using heat, PFA uses precisely delivered, high-energy electrical pulses to selectively affect heart muscle cells through a process known as irreversible electroporation. This allows abnormal cardiac tissue to be treated while largely sparing surrounding structures. The procedure is significantly faster, highly precise in targeting abnormal heart tissue, and associated with a substantially lower risk of injury to surrounding structures, particularly the oesophagus. Moreover, it is able to create more consistent lesions for durable treatment outcomes. Overall, catheter ablation for appropriately selected AFib patients achieves success rates of approximately 85%, with PFA improving procedural efficiency and enhancing the safety profile.
With continued advances in electrophysiology, conditions that once required prolonged procedures or lifelong symptom management can now often be treated with greater precision, shorter procedure times, and better patient outcomes. Pulse Field Ablation marks an important step forward in that journey, offering new hope for patients living with atrial fibrillation.
The author is a Lead Consultant - Cardiac Electrophysiologist, Manipal Hospital Old Airport Road.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
