Recent advances in electrophysiology (EP) allow cardiac electrophysiologists to offer patients more targeted, minimally invasive outpatient procedures for treating conditions such as atrial fibrillation (AFib) and other arrhythmias.

Dr. Zeshan Ahmad

“The field of electrophysiology is always pushing the envelope as much as possible in terms of new technology,” says Zeshan Ahmad, director of complex cardiac ablations for Johns Hopkins Medicine in the Greater Washington area. He practices mainly at Johns Hopkins’ Suburban Hospital while also seeing patients at The Johns Hopkins Hospital and Johns Hopkins Community Physicians in Urbana, Maryland. “We offer patients the gamut of EP technology and procedures, and we’re really advancing the EP footprint here in the Greater Washington area.”

Pulsed Field Ablation (PFA)

For patients with AFib, Ahmad performs pulsed field ablations (PFAs), which can decrease the risk of complications compared with other kinds of ablation, and he implants leadless pacemakers that reduce complications due to not having wires (leads). Ahmad, who operates at Suburban Hospital and The Johns Hopkins Hospital, joined the team about two years ago, bringing his ablation expertise. Physicians at Suburban Hospital now perform about 250–300 ablations per year.

PFAs rely on a process called electroporation, which uses electrical pulses to ablate heart tissue at a frequency specific to heart cells, reducing the risk of damaging surrounding organs like the esophagus and the nerves around the heart, which are potential side effects from traditional cryoballoon or radiofrequency ablations. The pulses, which are delivered through a catheter that is routed through the blood vessels of the leg, last seconds, making the procedure faster than other kinds of ablation. PFAs also lower the risk for an atrio-esophageal fistula, a rare complication with a high mortality rate.

PFAs are outpatient procedures, and can be performed at Suburban Hospital. Most patients are able to walk the next day and resume normal activity within a week.

Pulsed Field Ablation (PFA) for AFib: Clinical Insights with Dr. Zeshan Ahmad at Suburban Hospital

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Leadless Pacemakers

Some patients with AFib and other arrhythmias can be good candidates for leadless pacemakers, which are devices that are implanted into the heart with no wires, reducing the risk of infection or of the leads going bad. The device is smaller than a pacemaker with leads, and batteries can last 10–20 years. Leadless pacemakers are favorable options for patients with long-standing AFib, who need only their ventricles paced. There are also dual-chamber (meaning the atrium and ventricles) leadless pacemakers indicated for certain patients, which can replace traditional pacemakers. For younger patients, the device can be ideal since the long battery life means it needs to be replaced less often. Additionally, the lack of wires reduces the risk of long-term infection and complications that can result from routing wires through veins and those wires going bad, including difficulty removing the leads if they are causing malfunctioning or there is vascular stenosis.

Leadless pacemakers are also installed in a minimally invasive manner, through the femoral vein. It is an outpatient procedure, and most patients get back to regular activity within a day or two. The device is also safe for patients in MRI machines.

Both procedures are available at only a few facilities in the Greater Washington area. To perform them, a hospital needs a highly skilled group of cardiac electrophysiologists.

“Patients should go to a place that has all the right tools to take care of them, and with cardiologists who do a lot of these procedures,” Ahmad says. “Volume matters, and we do many of these cases throughout the Johns Hopkins Medicine system, but especially in the Greater Washington area.”