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Patients suffering from atrial fibrillation (AF) always have a mystery in their minds: about 1% of the population in Hong Kong, and more than 70,000 patients with AF, all know that AF may induce stroke and heart failure, and it is necessary to avoid worsening , Do you need an operation? The traditional pulmonary vein obstruction, commonly known as ablation, can indeed prevent the recurrence of atrial fibrillation. However, the operation time can be as long as two to three hours, and rare complications may occur. Don’t worry, consult your doctor to find a suitable treatment plan. Advanced technology also provides a new treatment option for patients with atrial fibrillation. The new technology “Pulsed Field Ablation” (PFA) recently introduced in Hong Kong not only cuts the operation time by more than half, but also significantly reduces the risk of complications.

In the past, the public’s impression of patients with atrial fibrillation was mainly older. After all, age is indeed the main 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. Atrial fibrillation patients, but in recent years there are also many young patients, only 30 to 40 years old, so the severity and coverage of atrial fibrillation cannot be ignored.

Because the heartbeat of patients with atrial fibrillation is unstable, the blood flow in the atrium slows down, and blood clots are easy to form. If the blood clots pumped by the heart reach the blood vessels in the brain through blood vessels, it may block the blood vessels in the brain and cause stroke. Some patients with atrial fibrillation have acute stroke as soon as symptoms appear, and even half of the body cannot move.

In addition, the fast and slow heartbeat can also cause palpitations in some patients, leading to heart failure, easy shortness of breath, and difficulty in going up stairs and even in daily life. Therefore, patients with atrial fibrillation are always alert to the two major risks of stroke and heart failure. Ordinary people should also pay attention to other high-risk factors that cause atrial fibrillation, including high blood pressure, thyroid or heart valve problems, etc., so that the disease can be detected and treated early.

Refractory to drugs

Many patients with atrial fibrillation use medication to prevent stroke and control heart rhythm. These include taking anticoagulant drugs (blood thinners) to prevent blood clots from forming and causing strokes; and antiarrhythmic drugs to reduce the number of atrial fibrillation attacks. However, drugs cannot cure the disease.

On the other hand, the cause of atrial fibrillation is the presence of abnormal cells at the junction of the patient’s atrium and pulmonary veins, which emit pulses to harass the atrium, causing atrial fibrillation and heartbeat disorder in the long run. Therefore, from a surgical point of view, eliminating the culprit of atrial fibrillation is the primary goal. Over the past two decades, traditional pulmonary vein occlusion (PVI) has used heat or freezing energy to ablate these abnormal cells.

Although pulmonary vein obstruction can reduce the chance of recurrence of atrial fibrillation, it faces limitations in complications and operation time. Including the possibility of ablation of other body tissues, rarer complications such as an atrial-oesophageal fistula (EF), which creates an abnormal tube between the atrium and esophagus), narrowing of the pulmonary veins, or damage to a nerve line in the right diaphragm, forming Phrenic nerve paralysis affects breathing, etc. Moreover, the operation time is relatively long, and it will take 2 to 3 hours at the fastest to complete.

Age is a risk factor for atrial fibrillation, and the older you are, the higher the chance of developing it.Photo: Getty Images, not a patient with atrial fibrillation

Pulse field fixed-point annihilates the source of disease

Ms. Lin (pseudonym), a patient with atrial fibrillation in her 70s, suffers from diabetes and high blood pressure at the same time. She has taken more than three antiarrhythmic drugs, but her condition cannot be controlled. On average, the disease occurs once every one to two weeks, and her heartbeat is extremely fast for a long time , can only stay at home when sick. She worries about the risk of rare complications with traditional ablation. After learning that pulsed field ablation was introduced in Hong Kong and the risk of complications was greatly reduced, I decided to try the new technology.

The original principle of pulsed field ablation is to generate energy by outputting a series of high-voltage currents that last for several seconds, so that the abnormal cells that cause atrial fibrillation will be destroyed, and a large number of micropores will be generated, thereby ablating them.

Since the energy critical point (Threshold) of abnormal cells is different from that of phrenic nerve cells, vascular cells, and esophageal cells, it is only necessary to send out specific voltage volts and time for abnormal cells to generate corresponding threshold energy, and you can It can be killed immediately after a single hit without affecting peripheral cells such as phrenic nerves, blood vessels, and esophagus, theoretically avoiding related complications. Moreover, pulsed field ablation only takes more than one hour to complete, and the operation time is shortened by more than half compared with traditional ablation. Therefore, pulsed field ablation breaks through the complications caused by traditional ablation and the limitation of operation time.

heart rhythm returns to normal

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.

After Ms. Lin mentioned above received the treatment, the arrhythmia problem that bothered her every week has disappeared, and she does not need to take antiarrhythmic drugs, only need to take blood thinners. Three months after the operation, the 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 Cardiology Specialist Dr. Fung Wing Hong
2023-08-07 05:00:00

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