Tennessee Valley adopts new ablation technique, completing a procedure in milliseconds

AFib affects millions globally, and when conventional treatments, including medications, prove ineffective, AFib ablation offers a crucial alternative. 

Historically, ablation techniques involve heat or cold to create scars on the heart tissue, which is essential for disrupting the irregular electrical signals that cause AFib. This process involves catheters inserted through a vein in the leg, which either generates heat through radiofrequency energy or applies extreme cold using a balloon filled with liquid nitrogen. 

 “If someone develops atrial fibrillation, it's because that tissue has become diseased, it's not acting normally,” TVHS Registered Nurse Keith Fly said. “It sends a whole lot of impulses and it's all erratic and it's super-fast... and that's what that scar does, it blocks all those extra impulses.” 

These methods, while effective, pose certain risks, particularly to surrounding tissues that are vital for proper bodily function, such as the diaphragm and esophagus.  

Recently, advancements in technology have given rise to a new ablation technique known as PFA, which offers significant health care benefits to patients over traditional techniques. 

“Pulsed Field Ablation is a new technology that delivers a pulsation of electrical signal just for a few milliseconds, and it doesn't heat up the tissue. However, [PFA] does cause a scar to form, which is what we want,” said Jay Montgomery, M.D., a TVHS cardiac electrophysiologist and Vanderbilt University Associate Professor of Medicine. 

PFA significantly reduces the risk of complications and injuries to adjacent structures associated with cardiac ablation. 

"[PFA] is not strong enough to affect any cells in the surrounding tissue. So, you don't get nerve tissue damage, or esophageal tissue damage like you could with just a thermal ablation device. [PFA} is great from a patient safety standpoint,” Fly, who works in the catheterization lab, said.  

Moreover, the brief duration of energy delivery in pulsed field ablation contributes to a more efficient procedure overall. It minimizes the time patients spend under anesthesia and reduces bleeding, allowing health care providers to potentially complete more procedures in a day.  

“Pulsed Field Ablation is an important step forward in improving the quality and safety of ablation procedures for patients with heart rhythm abnormalities, and TVHS is adopting this technology along with other major hospital systems,” Montgomery, who performs ablation procedures, said.  

Experts in the field have noted that pulsed field ablation is rapidly becoming the preferred technique for many ablation procedures. There is ongoing development and testing of additional PFA catheter technologies capable of addressing a wider range of arrhythmias. 

“In the future, it is likely that the majority of all heart rhythm abnormalities will be…treated with Pulsed Field Ablation rather than radiofrequency,” Montgomery said. 

At the Nashville VA, AFib ablation is the most common heart rhythm-related procedures, with about three procedures conducted weekly. The implementation of PFA has led to a notable shift, with the majority of these interventions now performed using the new technique instead of the traditional radiofrequency method.  

“The majority of all complex cardiac procedures that can be done in a cath lab or EP [ electrophysiology] lab are done at the Nashville VA, and this [PFA] is just a continuation of that level of excellence,” Montgomery said. 

With the adoption of Pulse Field Ablation, VA Tennessee Valley Healthcare System reaffirms its commitment to delivering cutting-edge medical treatments, thereby enhancing patient outcomes and establishing new benchmarks in cardiac health care. 

“For VA to be open minded enough to accept some of this new technology, it says a lot for the care we give the Vets because...patient safety comes first and this [PFA] is a safer methodology,” Fly said.