Mon Medical Center achieves state first in new AFib procedure
dbeard@dominionpost.com
Vandalia Health Mon Medical Center recently achieved another first-in-state in heart care by combining two technologies to treat atrial fibrillation – AFib. Farapulse images courtesy Boston Scientific
Mon Health Heart & Vascular Center electrophysiologist Dr. Salam Sbaity and his team combined the application of the Watchman and the Farapulse Pulsed Field Ablation system – both from Boston Scientific – in a single procedure.
AFIb is when the top two chambers of the heart – the atria – beat too fast and with an irregular rhythm (fibrillation), Boston Scientific said.
Sbaity explained why combining the two technologies is significant. AFib is the most common abnormal heart rhythm and West Virginia is among the top three states for prevalence.
AFib symptoms include palpitations, dizziness and shortness of breath, he said, and can lead to heart failure, blood clots and stroke.
There are two main advanced treatments. One is to treat the source of clots and stroke by closing the left atrial appendage, which extends off of the left atrium. The Watchman device is used to close it off.
The other is to treat the rhythm itself, he said. Muscle sleeves lead from the atrium into four pulmonary veins and are the source of electrical instability that can start the abnormal rhythm.
The abnormal rhythm is treated via cauterization, also known as ablation. The two forms of ablation used are extreme heat – radio frequency ablation – and extreme cold, cryoablation.
Boston Scientific announced in January 2024 that the FDA approved a new form, pulsed field ablation, with the Farapulse. The Farapulse catheter is tipped with five circular splines that can change shapes – including a flower – to fit into the entry of veins, circle and isolate them.
The Farapulse uses electrical pulses to create pores in the cell membranes and the cells die without heat or freezing, Sbaity said. It's safe for the structure of the veins and structures around them.
Boston Scientific reported that 12-month data from a pivotal clinical trial to directly compare the efficacy and safety of the Farapulse system against standard-of-care ablation found that Farapulse therapy was as safe and effective as conventional thermal ablation, with statistically shorter ablation times and a quicker learning curve for physicians.
'That made the procedure itself more effective and more safe,' he said. Sbaity and his partner, Dr. Matt Gaskill, performed the first Farapulse procedure in the state. 'In reviewing the literature for a while, we were seeing that this is the future of ablation.'
It's faster, more effective and safer, he said. Both are done via a catheter through the groin and into the same chamber of the heart. So it allows the flexibility to add another procedure without increasing time and risks.
The dual procedure has to be guided by internal imaging, and Sbaity took a further advanced step by employing intracardiac ultrasound – also called intracardiac echocardiography, ICE – instead of the usual transesophageal echocardiography, TEE.
TEE requires a second physician sending a scope down the throat, posing the risk of esophageal damage, the American Heart Association says. ICE can be performed by the primary physician doing the catheter procedure, avoiding the additional intubation and damage risks.
Only 8% of cases of appendage closure in country are done with ICE, Sbaity said.
Combining the two procedures, Sbaity said, allows him to offer the patient advanced treatment of both problems, with the risks associated with separate procedures pared down to one, and with reduced recovery time.
I think this is the wave of the future, combining the two procedures together whenever both are necessary,' he said.
The Mon team is participating in clinical trials comparing appendage closure against blood thinners for people who are not having problems with blood thinners, he said. One study showed closure is better statistically and better in terms of risks. 'I think the other two studies will probably prove the same.'
What that means, he said, 'if it goes that way, then anyone on blood thinner who goes for an ablation would as well want to close the appendage.' This would increase the number of patients who benefit from the combined procedure. He expects most patients will want it.
Sbaity said he has done just the one combined procedure so far, but five more are scheduled.
'We're proud here at Mon to offer the most advanced technologies for our patients in West Virginia,' he said, 'and we always want to be and have been at the forefront of innovation. That allows the population of West Virginia to have access to the most excellent, best care in the country.'
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