Roy Suryo
The Royal Victoria Hospital in Belfast has become the first in the United Kingdom to pioneer a groundbreaking new therapy for atrial fibrillation (AF), a prevalent and often debilitating heart rhythm disorder affecting an estimated 1.4 million people across the UK. This innovative treatment, known as the Volt Pulsed Field Ablation System (VPA), offers a significant advancement in managing irregular and abnormally fast heart rates when conventional medication proves insufficient. For patients like Michael Robinson, 67, who has been living with AF for five years, this cutting-edge procedure represents a beacon of hope for reclaiming a normal, active life.
Michael’s journey with AF began five years ago, a diagnosis that came as a profound shock, especially as he considered himself to be relatively active. The catalyst for his diagnosis was a personal tragedy – the death of his younger brother from a heart issue. This prompted a wave of health screenings for his family, during which his own AF was discovered. "I’d never heard of it," Michael recalled, highlighting the often-silent nature of the condition and the lack of widespread public awareness. The impact of AF on his daily life has been considerable. "It’s very debilitating," he explained. "On my worst day, I feel very tired, my heart rate increases rapidly – I could walk for two or three miles and be okay, but then I could walk for just 100 yards and it would hit me." This unpredictability has led to significant lifestyle restrictions, forcing him to cancel holidays and cut short attendance at social events. "I was to go on holiday and had to pull out, and recently attended a wedding reception but had to come home after half an hour," he shared, expressing his earnest hope that this new treatment will finally bring about a lasting normalization of his heart rhythm.
The Volt Pulsed Field Ablation System represents a paradigm shift in AF treatment due to its efficiency and improved patient experience. A key advantage is the increased capacity for patient treatment; the Royal Victoria Hospital can now treat up to three patients per day with VPA, a substantial increase from the single patient treated with previous methods. Furthermore, the recovery period is significantly shorter, and remarkably, patients are admitted and discharged on the same day. This streamlined process not only benefits individual patients but also contributes to alleviating pressure on hospital resources by freeing up valuable beds. A crucial aspect of the VPA procedure is that it is performed under conscious sedation, eliminating the need for a full anesthetic and the involvement of an anesthetist, which is particularly advantageous given the current global shortage of these specialists. Despite the inherent apprehension associated with any new medical procedure, Michael expressed confidence in the medical team: "It’s a wee bit scary, but I’ve a lot of faith in the staff," he stated as he was being taken to theatre.
Atrial fibrillation, at its core, is a disruption of the heart’s electrical signaling system. A healthy heart typically maintains a rhythm between 60 and 100 beats per minute. In individuals with AF, however, the upper chambers of the heart (the atria) beat irregularly and often significantly faster than this normal range, leading to a chaotic and inefficient pumping action. This progressive condition carries a heightened risk of serious complications, most notably stroke, due to the potential for blood clots to form in the irregularly beating atria and travel to the brain. It can also contribute to the development or worsening of heart failure, where the heart is unable to pump blood effectively to meet the body’s needs.
The symptoms of AF can vary widely in intensity and presentation. Common manifestations include palpitations, characterized by a sensation of a fast, irregular, or pounding heart. Other symptoms can include dizziness, overwhelming fatigue, shortness of breath, and chest discomfort. A concerning aspect of AF is that many individuals may live with the condition for extended periods without realizing it, remaining unaware of the significant health risks they are exposed to. AF episodes can be intermittent, occurring suddenly and lasting from mere seconds to several days, and in some cases, may even be asymptomatic, making early detection a significant challenge.
The Volt PFA System, developed by the global healthcare company Abbott, has been undergoing trials at the Royal Victoria Hospital since September, with approximately sixty patients having undergone the procedure to date. Dr. Nick Cromie, a cardiac electrophysiologist at the hospital who has been instrumental in performing the treatment, highlighted the multifaceted benefits of this new technology. "This benefits the hospital when it comes to patient flow and addressing waiting lists," Dr. Cromie explained. "Also, there is no need for an anesthetist, which is good as there is a global shortage of specialists." He elaborated on the precise mechanism of the Volt PFA System: "The Volt PFA System uses high energy electrical pulses to precisely target and treat abnormal cardiac tissue." This targeted approach is crucial as it "minimises the risk of damage to surrounding structures such as the oesophagus or blood vessels." Dr. Cromie emphasized the overall advancement: "This system is a big step forward in both patient safety and the hospital being a lot more efficient with its staff and use of theatre time."
The procedure itself involves a highly sophisticated technique. Dr. Cromie detailed the process: "We entered the bloodstream at the top of the inner thigh and then travelled up through the bloodstream all the way up to Michael’s heart – where we punctured a small hole to access the chamber where the problem is and then inflated a small balloon." This specialized balloon is key to delivering the treatment. "That helps us conduct electrical signals in the catheter into the heart tissue which needs treated," he explained. This minimally invasive approach aims to ablate, or destroy, the small areas of cardiac tissue responsible for triggering the irregular heartbeats.
Following the successful pilot phase in Belfast, the Volt PFA system is now being rolled out to several hospitals in England, signifying its growing acceptance and efficacy. Dr. Riyaz Somani, a consultant cardiologist at the University Hospitals of Leicester NHS Trust, was the first electrophysiologist in England to utilize this novel system. His initial impressions are overwhelmingly positive. "Our initial experience has been overwhelmingly positive, with all patients tolerating the procedure very well with excellent acute success rates," he reported.
Michael Robinson’s previous AF treatment involved cryotherapy, a method where small areas of heart tissue causing the irregular rhythms are frozen and destroyed. While minimally invasive, cryotherapy can be associated with discomfort, including gastric upset, and often does not result in a complete and lasting recovery for all patients. The Volt PFA System appears to offer a more effective and comfortable alternative.
Remarkably, just seven hours after being taken to theatre for his procedure, Michael was deemed well enough to be discharged and head home. His palpable sense of relief and renewed vitality was evident. "The Royal Victoria Hospital has been so good to me," he expressed with a broad smile. "I am feeling much better already – in fact, I might even go and play a game of football," he joked, a testament to the significant improvement in his quality of life and his newfound confidence in his heart’s ability to function normally. This pioneering therapy holds immense promise for countless individuals suffering from the debilitating effects of atrial fibrillation, offering them a chance to live fuller, more active lives.
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