Conquering AFib with pulsed field ablation: Ellen’s story

Ellen O’Brien of Huntingdon Valley, 80, is a vibrant, active woman who enjoys riding her exercise bike and playing soccer with her grandchildren. ­­­­­­­­­

When an irregular heartbeat called atrial fibrillation (AFib) threatened to slow her down, her cardiologist introduced her to a groundbreaking solution—pulsed field ablation (PFA).

A chaotic heartbeat leads to sleepless nights

“My heart was racing. I could feel it beating through my back,” said O’Brien, of the irregular, pounding heartbeat that was jolting her awake each night.

Exhausted and anxious, O’Brien began to avoid her bike and other activities, afraid she would strain her heart. She realized that the medication initially prescribed to help regulate her mild, brief episodes of heart palpitations was no longer effective, and her symptoms had progressed. She called her cardiologist, David L. Smith, MD, who saw her the next day for a physical exam and tests. The results revealed that AFib was contributing to her symptoms.

AFib occurs when abnormal signals in the heart’s electrical system cause a chaotic rhythm in the upper chambers (atria), affecting blood flow. The condition gets worse over time, and untreated AFib can lead to stroke, congestive heart failure, and other serious complications.

“Early rhythm control therapy for AFib, such as catheter ablation, has been shown to lower the risk of these adverse events,” said Robert Sangrigoli, MD, an electrophysiologist (heart rhythm expert) who was among the first in the region to treat patients with PFA.

PFA revolutionizes AFib ablation

Pulsed field ablation is a form of catheter ablation, a minimally invasive procedure in which the electrophysiologist applies energy to the heart, creating scar tissue to isolate the faulty signals that cause AFib. The signals are no longer able to affect the heart because scar tissue does not conduct electricity. Most patients can go home the same day.

PFA is revolutionary because it uses nonthermal pulsed electric field energy, which only affects heart tissue, according to Sangrigoli. Traditional catheter ablation techniques used to treat AFib, though effective, use thermal energy (heat or cold), and carry a small risk of unwanted injury to surrounding tissues, including the esophagus, aorta, lungs, and phrenic nerve (important for breathing), he noted.

At Penn Medicine, patients can receive pulsed field ablation at the Hospital of the University of Pennsylvania as well as at Penn Medicine Doylestown Health’s Atrial Fibrillation (AFib) Center, which is also one of the highest volume ablation centers in the Philadelphia region and a center of excellence for cryoablation and pulsed field ablation.

Advancing care with medical research

Electrophysiologists at Doylestown Hospital participated in the clinical trials leading to the first PFA delivery systems to receive U.S. Food and Drug Administration approval. So, while PFA is now available commercially, when O’Brien was considering the procedure, it was accessible only through clinical trials.

“I thought that by taking part in a research study, I could be helpful to younger people who may have AFib in the future,” she said.

O’Brien met with Susan Leonard, RN, MSN, a research coordinator, and part of the medical research team at Doylestown Health. Research coordinators lay the groundwork for clinical trials. This includes working with the Institutional Review Board (IRB), a committee that reviews and approves all research studies.

“The dedication of our physicians and staff as well as the support from Medical Research and the entire Doylestown Health team allows us to provide not only the highest quality care but gives us opportunities to participate in leading edge research so that our community of patients can feel confident they are receiving the best care possible,” Sangrigoli said.

After reviewing O’Brien’s medical history, Leonard and Sangrigoli determined that O’Brien was qualified to take part in the trial. The next step was a careful review of all aspects of trial participation and consent forms.

“We discussed the medical team’s responsibilities as well as O’Brien’s role as the patient because a clinical trial involves more frequent visits and closer monitoring,” Leonard said.

High-tech care with a personal touch

“I chose Doylestown Hospital because I was aware of the outstanding reputation of the staff and cardiac unit,” O’Brien said of the hospital’s Woodall Center for Heart and Vascular Care, a regional provider of quality, high-level cardiovascular care delivered with a personalized approach.

On the day of her procedure, as the team wheeled O’Brien into the EP operating room, she was amazed by the technology. “I felt as if I was entering a space capsule,” she recalled.

At the same time, she had never had a general anesthesia operation. "I was visibly nervous, and a young assistant took my hand and said, 'I'm not going to let go until you feel OK,” O’Brien said. “It was very comforting. He held my hand the whole time.”

Sangrigoli reached O’Brien’s heart by threading a thin, flexible tube called an ablation catheter through a vein in her groin and up to the heart. Using 3-D mapping technology, and low-dose X-ray guidance, he precisely targeted the energy pulses to block the faulty signals that were causing O’Brien’s AFib.

O’Brien has had no symptoms since her PFA procedure last year.

“Overall, it was a wonderful experience. I’m playing soccer with my grandkids, riding my bike, and I have energy. Everyone was so kind, and I received excellent care,” she said. “I went to the right place.”