First for Africa: heart rhythm disorder treated with new technology

Posted on 14 March 2023

For the first time on the African continent, a series of fourteen patients with atrial fibrillation – the most common heart rhythm disorder in people older than sixty years – were treated with new ablation technology to ensure normal heart rhythm without atrial fibrillation.

Dr Razeen Gopal, renowned cardiologist and electrophysiologist at the Cape Town Atrial Fibrillation Centre (CTAFC) based at Mediclinic Panorama, performed the first cases in Africa of the latest pulsed field ablation on 27 February 2023 using the FarapulseTM Pulsed Field Ablation System.

The new technology, known as electro-poration or pulse field ablation, may lead to a revolution in the treatment of all types of heart arrhythmias.

Following the procedure, the first patient on the continent, Robert Reinecke (59) from Proteavallei, felt he had experienced a very rapid and entirely pain-free procedure and was feeling very well.

Mr Reinecke together with other patients have experienced relief from symptoms following the procedure. Stringent follow-up for the next 12 months will confirm the sustained effect of their pulmonary vein isolation.

The roll out of pulsed field ablation (PFA) in Africa follows the establishment of this new technology in Europe, the UK and two countries in the Middle East. It is not yet commercially available in the USA.

Prof Nico Reinsch, electrophysiologist from Essen in Germany, who has performed more than 100 PFA’s at the center in Essen, supervised the Cape Town cases. According to Reinsch it can be described as “revolutionary and not merely evolutionary”.

In the eighties cardiologists attempted to treat arrhythmias with direct electrical pulses, but abandoned these attempts when they could not control and direct the electrical stimuli with sufficient accuracy to restrict damage to surrounding tissue. The new technology now offers well–controlled firing of electrical pulses of 2000 Volt lasting only microseconds to specific targeted areas in the heart.
PFA differs from radiofrequency ablation using heat, and cryo-ablation using cold. But, as with other ablation techniques in the treatment of atrial ablation, a catheter is directed via the femoral vein to the left atria. Through the catheter, a folded tip is deployed, which when opened resembles a basket and then a flower with five petals. It is through small points on the petals that the electrical pulses are fired at a specific frequency which shoots small pores in heart cells only, without causing harm to other structures and cells which are sensitive to higher frequency outputs. “If the sensitivity levels of heart cells were not lower than the levels of surrounding structure and tissues, PFA would not have been possible”, Prof. Reinsch explained.

The benefits of PFA include the following:
– It is swift. An experienced and able electrophysiologist can complete the ablation in one minute and four seconds. This lowers the risky time in the left atrium, lowering the ultimate risk for complications.
– It is safer than other ablation techniques for atrial fibrillation, because the heart cell sensitivity is lower than for surrounding tissue. The soft tip of the catheter lowers the risk for perforation of the left atrium.
– It is as effective as other existing ablation techniques for atrial fibrillation.

Although the commercial use of PFA is new, clinical studies performed since 2018 showed very promising results and centres in Europe and UK where PFA had been rolled out, deliver the same good results.

“I am excited about the new technology and think that PFA may be the technology of the future. I think the future heralds expanded indications for possibly all arrhythmias to be treated with PFA. I would not be surprised at all if arrhythmias such as flutters, atrial tachycardia and WPW syndrome in children are managed in the similar fashion in the future. Research is already underway to test a pointed tip catheter to deliver the electrical pulse in pinpoint fashion,” Dr Gopal said.