AFib Research from UCSF and Beyond
Pulsed Field or Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation
For the last 26 years, thermal ablations (destroying, also known as cauterizing, small areas of tissue with heating) have been used to treat atrial fibrillation (AFib), but a recent study called ADVENT, proposes a new alternative. The study aimed to prove that the pulsed field ablation (PFA) procedure is just as effective and safe as thermal ablation in patients who have paroxysmal AFib. Dr. Edward Gerstenfeld, Professor of Medicine and Chief of Cardiac Electrophysiology at UCSF, authored a paper based on the findings of the study.
The rapid, high voltage technology of PFA is predicted to limit the damage caused to tissues beyond the ablation site. In thermal ablations, it is believed that the effects of the procedure may extend to surrounding tissues. In this study two types of thermal ablation methods were used: radiofrequency, which uses heat, and cryotherapy, which uses cold.
In this study, a total of 607 patients with paroxysmal AFib were enrolled. Half of the patients were assigned to undergo PFA, and the other half were assigned to undergo thermal ablation.
ADVENT found that PFA is as effective as thermal ablation, with a shorter procedure time on average. Imaging conducted during the study found that significant narrowing of the pulmonary vein, a potential complication of ablations, did not occur in either group, but that those who received PFA had less narrowing than those who had a thermal ablation.
A study similar to ADVENT found that two to five years after undergoing PFA, patients saw less recurrences of AFib symptoms. ADVENT study participants only included people with paroxysmal AFib, not those with permanent or other non-paroxysmal AFib. As surgeons become more familiar with PFA, patients with AFib may be able to benefit from a quicker and safer treatment for paroxysmal AFib.
To read the article click here.
References:
- Reddy, V. Y., Gerstenfeld, E. P., Natale, A., Whang, W., Cuoco, F. A., Patel, C., Mountantonakis, S. E., Gibson, D. N., Harding, J. D., Ellis, C. R., Ellenbogen, K. A., DeLurgio, D. B., Osorio, J., Achyutha, A. B., Schneider, C. W., Mugglin, A. S., Albrecht, E. M., Stein, K. M., Lehmann, J. W., & Mansour, M. (2023). Pulsed Field or Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation. New England Journal of Medicine, 389(18), 1660–1671. https://doi.org/10.1056/nejmoa2307291
Minimum National Prevalence of Diagnosed Atrial Fibrillation Inferred From California Acute Care Facilities
Atrial fibrillation (AFib) is the most common heart arrhythmia, a leading cause of stroke, and a substantial socioeconomic burden for the healthcare system. An AFib diagnosis is associated with higher risks of dementia, heart failure, and premature death. However, prevalence data for AFib has not been updated for more than twenty years. This data predicted that 3.3 million adults in the United States would have AFib by 2020. A recent study co-authored by Dr. Jean Jacques Noubiap, UCSF Postdoctoral Scholar, and Dr. Gregory Marcus, Professor of Medicine and Associate Chief of Cardiology for Research at UCSF, showed that AFib may affect three times more people than previously thought.
The study used healthcare databases from 2005 to 2019 to assemble a cohort of over 29 million patients aged 20 years or older who received hospital-based care in California. It then identified the prevalence of AFib cases, as well as comorbidities with conditions like hypertension, diabetes, and heart failure. The study found that about 2 million out of nearly 30 million people (6.8%) were diagnosed with AFib during this period. Prevalence of AFib increased from 4.5% between 2005 to 2009 to 6.8% between 2015-2019. AFib was more prevalent in men, older people, and Whites and Asians, but numbers increased over time across all demographic groups.
Applying the California estimates to the entire United States, the study estimated that there were at least 10.5 million people in the country with AFib in 2019. That is nearly 5% of the adult population and substantially higher than the 3.3 million projected in the past. International reports show similar trends. Some factors that may explain the rise in AFib include population growth, aging, and the increased prevalence of other risk factors like hypertension, chronic kidney disease, and heart failure. Healthcare providers are also better able to detect AFib.
The study’s findings have implications on public health and healthcare utilization. Given the health impacts and prevalence of AFib, the authors argue that greater resources should be allocated to the prevention and management of not only AFib but its common comorbidities. Moreover, the national estimates are likely even higher than presented in the study.
To read the article, click here.
References:
- Dai, H., Zhang, Q., Much, A. A., Maor, E., Segev, A., Beinart, R., Adawi, S., Lu, Y., Bragazzi, N. L., & Wu, J. (2020). Global, regional, and national prevalence, incidence, mortality, and risk factors for atrial fibrillation, 1990–2017: Results from the global burden of disease study 2017. European Heart Journal – Quality of Care and Clinical Outcomes, 7(6), 574–582. https://doi.org/10.1093/ehjqcco/qcaa061
- Krijthe, B. P., Kunst, A., Benjamin, E. J., Lip, G. Y., Franco, O. H., Hofman, A., Witteman, J. C., Stricker, B. H., & Heeringa, J. (2013). Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. European Heart Journal, 34(35), 2746–2751. https://doi.org/10.1093/eurheartj/eht280
- Noubiap, J. J., Tang, J. J., Teraoka, J. T., Dewland, T. A., & Marcus, G. M. (2024). Minimum national prevalence of diagnosed atrial fibrillation inferred from California Acute Care Facilities. Journal of the American College of Cardiology, 84(16), 1501–1508. https://doi.org/10.1016/j.jacc.2024.07.014
- Wu, J., Nadarajah, R., Nakao, Y. M., Nakao, K., Wilkinson, C., Mamas, M. A., Camm, A. J., & Gale, C. P. (2022). Temporal trends and patterns in atrial fibrillation incidence: A population-based study of 3·4 million individuals. The Lancet Regional Health – Europe, 17, 100386. https://doi.org/10.1016/j.lanepe.2022.100386
