Safe treatment method for atrial fibrillation

Study on pulsed field ablation with promising results.

An international study involving the Heart Center of the University Medical Center Göttingen (UMG) shows that pulsed field ablation is more effective, gentler and associated with fewer complications than other methods for treating atrial fibrillation. With the pulsed field method, the areas of the heart tissue responsible for the development of atrial fibrillation are specifically sclerosed by means of electrical impulses and not by heat or cold as with other methods. The results of the MANIFEST-17K study were published in the renowned journal Nature Medicine.

According to the German Heart Foundation, around 1.8 million people are affected by atrial fibrillation, or AFib for short. Typical symptoms include palpitations, shortness of breath, chest pain, dizziness and reduced exercise tolerance. The consequences of untreated atrial fibrillation can be serious. Among other things, it is one of the most common causes of a stroke. In order to normalize the heartbeat, so-called ablations are performed at the Heart Center of the University Medical Center Göttingen (UMG) in addition to drug therapy. Thin plastic tubes fitted with electrodes, known as catheters, are placed in the heart and the areas of heart tissue responsible for atrial fibrillation are targeted with electrical impulses.

Dr. Leonard Bergau, Deputy Head of the Clinical Electrophysiology Unit and Senior Physician in the Department of Cardiology and Pneumology at the University Medical Center Göttingen (UMG), during a pulsed field ablation. Credit: umg/hzg, Eva Meyer-Besting

In the international MANIFEST-17K study, the team led by Dr. Leonard Bergau, Deputy Head of the Clinical Electrophysiology Unit and Senior Physician in the Department of Cardiology and Pneumology at the UMG, investigated the safety and efficacy of pulsed field ablation compared to conventional ablation procedures in more than 17,000 patients. In this method, the diseased areas of the heart are obliterated using electrical impulses. It was shown that the complication rate with pulsed field ablation is very low compared to other catheter procedures. While some complications, such as scarring of the pulmonary vein, also known as pulmonary vein stenosis, cannot be ruled out with thermal ablations such as sclerotherapy using heat, there were no reports of such pulmonary vein stenosis, diaphragmatic paralysis or injuries to the esophagus during the study. “The study confirms what we have been observing for some time: Pulsed Field Ablation is a very effective and particularly gentle method of treating atrial fibrillation,” says Dr. Bergau. “The low complication rate is an excellent result and enables us to treat patients even more safely and gently.”

The results of the MANIFEST-17K study were published in the renowned journal Nature Medicine.

“Catheter ablation of atrial fibrillation is now considered the treatment method of choice in invasive electrophysiology for symptomatic patients in whom the aim is to permanently maintain a regular heartbeat, especially if drug therapy is not sufficiently effective,” explains Dr. Bergau.

With over 300 atrial fibrillation ablations in 2023, the UMG Heart Center is one of the largest atrial fibrillation centers in Lower Saxony. “In addition to heat ablation, radiofrequency ablation, we also use cold ablation therapy, a balloon catheter procedure, and the new pulsed field ablation, which works with electrical impulses,” explains Dr. Bergau. Pulsed field ablation has already been used at the UMG Heart Center for two years.

About the study

The MANIFEST-17K study collected data from over 17,000 patients treated at 116 different medical centers worldwide. The patients were on average 64 years old and 37.5 percent were female. Around 58 percent of the study participants suffered from episodic, brief atrial fibrillation, 35 percent had more frequent, longer-lasting atrial fibrillation and just under six percent had long-term atrial fibrillation. Around one percent suffered from atrial flutter or atrial tachycardia, in which the heart beats very fast for a few minutes, also known as palpitations.

The researchers analyzed various complications that occurred in the treated patients, including vascular events such as pericardial tamponade, an accumulation of fluid around the heart, and strokes. Particular attention was paid to avoiding potential damage to tissues such as the esophagus or diaphragm, which can be a risk with traditional procedures.

“The study has shown that we are using the right procedures at the Heart Center. We are pleased that pulsed field ablation is an excellent option for treating our patients and all the more pleased that we can offer them this treatment method here in Göttingen,” says Prof. Dr. Gerd Hasenfuß, Director of the Department of Cardiology and Pneumology and Chairman of the UMG Heart Center.

Wissenschaftliche Ansprechpartner:

University Medical Center Göttingen, University of Göttingen
Department of Cardiology and Pneumology
Dr. Leonard Bergau
Robert-Koch-Str. 40, 37075 Göttingen
Phone +49 551 / 39-62983
herzzentrum@med.uni-goettingen.de
herzzentrum.umg.eu

Originalpublikation:

Ekanem, E., Neuzil, P., Reichlin, T. et al. Safety of pulsed field ablation in more than 17,000 patients with atrial fibrillation in the MANIFEST-17K study. Nat Med 30, 2020–2029 (2024). https://doi.org/10.1038/s41591-024-03114-3

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