Like much of healthcare, the roots of modern cardiology may be traced back to Hippocrates. Considered the father of medicine, Hippocrates was the first to describe the sudden death of people who suffered from severe and frequent fainting spells – a description now believed to be the earliest observation of sudden cardiac death.
In the 2,400 years since this observation, our understanding of the heart and how it works has advanced by leaps and bounds. Now, not only do we know what keeps the heart going, we understand what is often at play when the heart suddenly stops, which can generally either be attributed to a malfunction within the circulatory or electrical system of the organ.
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Of course, many people are familiar with circulatory malfunctions, which are caused by a blockage in a coronary artery that cuts off the blood supply to the heart muscle, resulting in a heart attack. Fewer are familiar with electrical malfunctions of the heart, which can cause irregular or abnormal heart rhythms – or arrhythmias – that leave the heart unable to pump blood throughout the body.
This lack of familiarity may be the very reason that many people do not seem to know about one of the most important advancements in treating electrical heart malfunctions – cardiac ablation. And because catheter ablation is not well known, people who could directly benefit from the procedure often delay much-needed treatment or don’t receive the treatment at all.
Understanding the heart’s electrical system
The heart’s electrical system is a critical component of how the heart works. Pulses of electricity are generated in a special structure within the heart called the sinus node. These pulses stimulate the heart muscle to contract, which allows it to pump blood throughout the body.
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Christopher Piorkowski Christopher Piorkowski is vice president and chief medical officer of the electrophysiology division at Abbott, which he joined in 2020. Before joining Abbott, Dr. Piorkowski established and led the Department of Electrophysiology at the University of Dresden to become an internationally recognized site of medical excellence, at the forefront of clinical research, training […]
A breakdown or disruption in electrical activity can cause the heart to beat irregularly, something that is known as an abnormal heart rhythm. While there are several different types of abnormal heart rhythms, the most common is atrial fibrillation, which is caused when the upper chambers (atrial) of the heart beat too fast and out of sequence with the lower chambers (ventricles).
Without treatment, electrical malfunctions of the heart can lead to a number of symptoms, including palpitations, fatigue, dizziness, shortness of breath and exercise intolerance. In some cases, it can even lead to heart failure, stroke and even death.
The development of cardiac ablation
Even though many people may not be familiar with cardiac ablation, the first catheter ablation procedure was actually performed 40 years ago. Up to that point, most arrhythmias were addressed through drug therapy or major surgery. Not all patients are candidates for surgery, so physicians and researchers searched for an alternative treatment, leading to catheter ablation. Catheter ablation is a minimally invasive procedure that allows a doctor to reach the heart by inserting a thin tool through a small hole in a vein or artery in the leg and selectively disrupting abnormal tissue, a process known as “ablation.” When the tissue is ablated, a scar forms, which is intended to disrupt the abnormal electrical activity in that part of the heart, restoring normal electrical signals.
Once catheter ablation was proven to be effective, advancements quickly followed. Over time, catheters became more responsive with innovations like the first steerable sheath that delivers catheters more accurately to the precise area of the heart; the first flexible, irrigated tip that improves safety and helps reduce the time it takes to complete the procedure; and the first mapping and diagnostic technologies that create a three-dimensional model of the heart and allow doctors to pinpoint areas causing problems.
And as the procedure has continued to advance, the outcomes have continued to improve. A recent study that included more than 27,000 patients with atrial fibrillation showed that catheter ablation not only reduced the risk of death when compared to drug intervention, but it also resulted in fewer hospital admissions because of heart failure.
Underutilization of catheter ablation
Despite the success of the procedure, it is still underutilized. It is estimated that about 700,000 people worldwide suffering from atrial fibrillation will be treated with a cardiac ablation procedure in 2022. By contrast, 33 million people around the globe suffer from atrial fibrillation, a number that is expected to double by 2050.
Part of the gap could be that catheter ablation is still considered a highly specialized treatment that is generally performed by an electrophysiologist, a physician who concentrates in electrical issues within the heart. And there are limited cardiac electrophysiologists nationwide and around the world. In 2020, only 2,790 U.S. physicians had a valid certificate in clinical cardiac electrophysiology compared to 28,824 in cardiovascular disease.
Procedures could also be lagging because referring physicians and their patients feel more comfortable with drug therapy – given that the first antiarrhythmic drugs were introduced more than 100 years ago. But today, we know that ablation offers superior efficacy in successfully treating cardiac arrhythmias and similar safety when compared to drug therapy. When looking specifically at heart failure patients, it is even superior in its ability to reduce mortality.
It could also be that people are just not aware that cardiac ablation is an option or the advantages it provides to them. Regardless of the reason, the result is that a 40-year-old advancement that has been refined, improved and proven to be highly beneficial to patients continues to be underutilized.
Continued advancement of cardiac ablation
But advancements in catheter ablation are continuing. With the advancements in technology, procedures have become faster, safer and more effective. As a result, physicians are increasingly utilizing the treatment and learning to treat more difficult patients with more difficult arrhythmias.
These advancements will have a significant impact on patients with heart failure. Patients suffering from heart failure are often at higher risk of developing an arrhythmia. Timely, successful and effective treatment of these arrhythmias in heart failure patients impacts life expectancy and survival. For the millions of people worldwide who suffer from heart failure, addressing arrhythmias early could mean the difference between life and death.
Catheter ablation is an essential procedure for patients around the globe. The clinical relevance of this procedure has been well documented and has been recognized by physician societies around the world, including the American Heart Association and as part of European guidelines – further highlighting the exponentially increasing relevance of catheter ablation. With so much supporting data and real-world success, it is time for catheter ablation to become a routine treatment option for patients suffering from arrhythmias.
Christopher Piorkowski is vice president and chief medical officer of the electrophysiology division at Abbott, which he joined in 2020.
Before joining Abbott, Dr. Piorkowski established and led the Department of Electrophysiology at the University of Dresden to become an internationally recognized site of medical excellence, at the forefront of clinical research, training and education. The author of more than 240 scientific publications, Dr. Piorkowski has made contributions to innovations in disease understanding, novel ablation approaches and medical technology advancements.
In his clinical career, he has treated patients in Europe, Asia and South America and was elected president of the Arrhythmia Working Group of the German Cardiac Society. Dr. Piorkowski also served as a scientific reviewer for numerous EP journals, medical universities, the medtech industry and venture capital organizations.
