Original subtitles

[narrator] On "Tomorrow's World Today," we explore the cutting-edge

advances that are shaping four different worlds.

The world of inspiration,

where the wonders of the natural world amaze

and inspire us.

The world of creation,

where ideas come to life from traditional arts.

The world of innovation,

where ideas and inventions move us all forward.

The world of production,

where innovations are mass-produced

to improve our lives.

From Inventionland World Headquarters,

here's your host, George Davison!

Did you know that a hidden electrical grid

powers your heart?

Welcome to "Tomorrow's World Today."

Your heart beats roughly 100,000 times,

every day.

That's 35 million pulses of life a year.

And for centuries, this spark, it was a mystery.

Until the 1700s,

when these pioneers, Galvani and Volta,

discovered that biology and electricity were linked.

They asked a question at that time that was gonna take

over 200 years to answer.

If electricity was powering the heart,

could we also use it to heal the heart?

Well, it took until the early 1900s,

when Willem Einthoven first gave us the EKG.

That was a map of the heart's rhythm.

And we could finally visualize our electrical pathways.

But for the next 50 years, we lacked a way to repair them

without invasive surgery.

So for decades, the standards were

to use a big blade

to make the cut -- open heart surgery.

Now that saved lives,

but with recovery times up to a year, that toll's immense.

So the process was innovated again in the 1980s,

when we moved from the blade to the catheter,

using extreme heat or cold

to cauterize and rewire the heart from the inside out.

Today, though, we've reached a new frontier --

pulsed electric fields.

This technology doesn't burn or freeze.

It uses ultra-rapid pulses

that shoot holes into that problematic cell to kill it,

leaving those healthy tissues unharmed.

And the recovery time is near zero.

Now, I'd like to learn more,

so I'm gonna send Greg to the world of innovation

to show us how a pulse of energy

is rewriting the human heartbeat.

It might just be

the most important discovery of our lifetime.

[Greg] Heart disease is one of the most prevalent

medical issues facing the world.

In this episode, we'll explore contemporary

and cutting-edge diagnostic and treatment technology

in the world of cardiac medicine.

But first, we're here at Duke University Medical Center.

We'll meet with Dr. Jonathan Piccini

and discuss some of the basics of heart health

and one of the most common ailments

facing cardiac patients today.

-Dr. Piccini, nice to meet you. -Nice to meet you.

Tell me about your role here at Duke Medicine?

Sure, I'm a professor of medicine

here at Duke in the School of Medicine,

and I also direct the cardiac electrophysiology program

for the Duke Health System,

which is the part of cardiac care that focuses

on heart rhythm problems.

OK, well, speaking about heart disease in a more

broad sense, what's the impact worldwide right now?

I think most people are familiar with cardiac disease.

It's the leading cause of death in the United States

and across the world.

More than 18 million people die of cardiovascular disease

every year, and so people are familiar with many forms of it,

including stroke and myocardial infarction and heart failure.

But people are often less familiar with

the heart disorders that affect the electrical system.

And the most common disorder that affects more than

33 million people across the world

is an electrical disorder known as atrial fibrillation, which,

colloquially people refer to it as AFib.

And this is what you specialize in,

and I'd really like to explore more about that.

Yeah, let's talk some more and learn some more.

So, Doctor, you mentioned that AFib is very common.

Exactly how common is it?

Yeah, it's so common that ultimately, one in four

Americans are going to develop atrial fibrillation at some

point in their lifetime.

Does this affect people of all ages,

or is it mostly older folks?

It's predominantly a disease of aging.

So, the older we get,

the more common atrial fibrillation is.

What exactly is happening in the heart

when AFib starts to present itself?

Yeah, so, when the heart's functioning normally,

there's an orderly progression of electrical activity

through the heart, through the top chambers

down to the bottom chambers.

And when the heart goes into atrial fibrillation, instead of

the electricity moving orderly through the top chambers,

kind of becomes chaotic and completely erratic.

And when that happens, those top chambers,

the booster pumps of the heart, do not function normally.

Well, what are some of the symptoms that somebody

might be experiencing that

would lead them to believe that they have AFib?

Some individuals will experience their heart racing.

Others will experience their heart skipping beats

or pounding irregularly.

Other individuals, because those top chambers are

not functioning efficiently, will have a loss of energy

or fatigue or difficulty exercising.

How does somebody know that that's coming from AFib and not

some other disease?

A lot of those symptoms are nonspecific.

So, the way we make a diagnosis is we get an actual recording

of the heart rhythm because it is, after all,

electrical condition.

Someone has those symptoms and they go to their doctor,

they may get an EKG that shows AFib, or they may wear

a monitor for several days or weeks that documents

the atrial fibrillation.

Other times, people will have an irregular pulse,

and that will lead to someone doing electrical investigation.

[Greg] What are some of the treatments

that are available now and what are some of

the innovations that are coming down the road?

So, the American Heart Association

and the Heart Rhythm Society really emphasize

three key areas.

One is reducing the risk factors and the problems

that cause or perpetuate atrial fibrillation.

Another is making sure people are prevented against stroke,

because stroke can be a complication

of atrial fibrillation.

And then the third part of treating atrial fibrillation is

helping people feel better.

And that has several components.

One is making sure that the heart rate doesn't race

and get too high.

Probably the most important these days is

getting someone back into normal rhythm,

getting them back into sinus rhythm.

And there's a variety of tools

we have at our disposal to do that.

Sometimes we put a patient asleep and shock their heart

back into normal rhythm. That's called a cardioversion.

Other times we can treat patients with medications

that help the heart stay in normal rhythm.

But one of the most exciting developments is something

called ablation, where we go into the heart and we target

the areas that initiate and trigger and maintain

atrial fibrillation, and we destroy those tiny areas

of heart tissue. -[Greg] All right.

Well, Doctor, thank you very much.

-It's been great. -Thank you for visiting.

[Greg] At Duke University Medical,

we learned from Dr. Piccini

about the basics of AFib or atrial fibrillation.

Now here at the Abbott Advanced Technology Center,

we'll talk with Dr. Christopher Piorkowski

about the cutting edge innovations being used

to treat this very common heart condition.

Christopher, let's talk about ablation and how that works

as a therapy for atrial fibrillation.

Greg, this is an important question.

In the United States, around 12 million patients

are suffering from atrial fibrillation.

Atrial fibrillation is an abnormality

of the heart rhythm, and it has impact on quality of life,

life expectancy, stroke risks, healthcare costs.

So treating those patients is really, really important.

Now, ablation in principle means destroying

electrically unhealthy tissue.

There is a close analogy to cancer treatment.

In cancer treatment, physicians destroy

the cancer tissue.

In cardiac-electrophysiology,

the physicians try to eliminate electrically unhealthy tissue.

You can imagine that's not an easy task.

When this all started, it was basically open heart surgery.

So it was a very, very invasive

procedure to have this done. -Correct.

We are standing on the shoulders of surgeons.

They taught us how to treat patients.

Later, it transitioned into minimal-invasive therapies,

therapies that were introduced with a catheter over the groin

into the heart.

And the technological evolution happened around

the energy sources.

For 20 to 30 years, radiofrequency energy was

the main energy source to destroy

the electrically unhealthy tissue,

and it has done a lot of good to patients.

It has moved the field forward.

However, right now, we are in a moment of big transition

to a new energy source.

[Greg] Pulsed field ablation,

and that's what we're gonna learn about today.

-I'm very excited. -Exactly.

Pulsed field ablation is a new kid on the block,

has a lot of promises.

We in Abbott spend many, many resources to build

pulsed field ablation catheters. I would like to show you one.

Excellent. Let's go see.

Christopher, there are other pulsed field ablation

systems out there. What makes Volt so unique?

I would put it into one word.

Volt was designed purposefully from the ground up.

The main purpose in the design was to improve

the lesion quality.

We have talked about how relevant lesions are

for effective treatment of atrial fibrillation.

And there are multiple single design elements

that went into this concept.

I would just want to highlight a few of them.

You see the eight splines of the catheter.

These splines are flat and directing the energy

into the tissue.

Then, comes the balloon.

The balloon is, of course, a great tool for simplicity

of handling and stability, etc.,

but it's also a great insulator.

So it insulates the blood and pushes the energy

into the tissue to create deeper lesions.

It also protects the red blood cells from the energy field

so that the energy field cannot destroy red blood cells.

So all these elements contributed

to the catheter design.

Again, it was built from the ground up

as a new concept, as a new catheter.

And that's what we're seeing here.

So this is really revolution

and not evolution. -Yes.

-Well, I'd really love to see it in action. -Let's go.

So, Christopher, this room is really impressive.

Where are we?

It's a simulated EP lab where we train physicians.

And like in a real environment,

we have Lauren as a support team in the control room.

Great. Now, EP, electrophysiology.

And that's basically the basis of Volt catheter system.

So let's dive right in. Tell me all about it.

So we've talked about the simplicity of the design,

which was intentional and built from the ground,

and the ease-of-use component and the safety aspects.

And I want to showcase this to you by handing the case

over to you.

OK, I'm ready.

What you see here is a hollow tube, a so-called sheath,

sitting inside the left atrium.

You can turn it a little bit to see how you can stare with it,

advance it, pull it back.

Inside is already the Volt catheter.

And now I would ask you to advance the Volt catheter

out of the sheath. OK, stop right there.

Inflate the balloon, please.

You will see how the device goes up.

Yeah, perfect.

And now advance the whole system

into the pulmonary vein, gently.

Perfect.

You're sitting now in the left upper pulmonary vein.

All electrodes have good tissue contact.

Everything is blue.

That's a perfect spot for ablation.

And we initiate the first ablation.

The mapping is really incredible.

This is really where the doctor

is able to see exactly what's happening.

Oh, we spent so much effort to make this really accurate.

-How does it feel to manipulate? -It feels very simple.

Every flash is actually the energy being applied

to that vein. -Yes, exactly.

Now the ablation is done, actually.

You see the blue dots is where

the little scars have been placed.

Now I would like to ask you to rotate the catheter

a little bit into the offset.

Just rotate it gently.

Pull it back if it's a little difficult.

Perfect, you're there.

And now keep it in between, keep the rotation

on the catheter, and we do the second application.

This is designed to have two applications

to isolate the pulmonary veins.

In clinical routine, we see four to five,

because the pulmonary veins change in their sizes.

But after that, you see like a continuous ring of

little scars around the pulmonary vein.

And that's the purpose of the therapy,

to isolate the pulmonary vein with a little scar zone,

because inside the pulmonary vein,

that's where the tissue sits that initiates

the wrong electrical impulses that create atrial fibrillation.

So basically, all of those little scars are going to keep

those errant electrical systems that are creating

the arrhythmia from even reaching the vein.

Yeah, you jail them away.

Christopher, amazing technology,

thank you very much. -Has been a pleasure.

[Greg] So far in this episode,

we've learned about the basics of atrial fibrillation

and the new cutting-edge technology --

pulsed field ablation being used to treat it.

And now we're here at St. Bernard's Medical Center

in Jonesboro, Arkansas.

We're going to talk with a physician

using this new technology in the real world.

Let's head inside right now and talk with Dr. Devi Nair.

-Hi, Dr. Nair. -Well, hello.

Well, you are an electrophysiologist.

Tell me a little bit about what that is.

So, an electrophysiologist is an electrician for the heart.

So when my patients think about the heart,

they think about the plumbers

who take care of the arteries.

I take care of the electrical system,

which keeps the heart in pace.

I've been learning about pulsed field ablation

and how that's a relatively new technology

that's being used to treat AFib.

Tell me how that works for you.

So, ablation is a technology that we have used for decades

to take care of cardiac rhythm problems.

Historically, when we used ablation,

we've always used thermal energy.

We've used heat or cold energy,

which means we go into the heart,

we find the erratic signal,

we either freeze it away with cold

or we burn it away with heat.

The problem with thermal energy is that it causes

collateral damage.

Now, pulse field ablation is a very new technology that

delivers short bursts of electrical energy

into the erratic area in the heart

and destroys those abnormal tissues,

which allows us to restore the heart's rhythm back,

but without causing collateral damage.

Well, what are some of the other advantages for you

as a physician and for your patients?

Number one for my patients has always been safety.

Obviously, for me as well,

being able to deliver ablation strategies

without having to worry about many of the older safety

concerns that we had is big.

The other thing that stands out

is how quick these procedures are,

which means the patients are not really under sedation

or anesthesia for too long,

which means their recovery is quicker.

And most of my patients are actually back to living

their normal lives within a few days, which is, I think,

a huge advantage for the patients.

Yeah, that's amazing.

I would love to learn more about this.

Absolutely. Let me show you into the lab.

Well, Doctor, this lab looks almost exactly like

the simulation lab I was in with Dr. Piorkowski.

Now, when I got my hands on with Volt, we used

a mapping screen like this, and was -- it's amazing.

But what is this?

Well, Greg, this is the lab that I work in,

and these are images from a real case

with the Volt PFA system that we recently did.

So what you're seeing over there is an intracardiac echo,

which is a camera inside the heart, which shows us

how the Volt balloon is sitting inside the heart

and in proximity or in touching the cardiac tissue,

and how it integrates well with the mapping system.

And this kind of gives me a very seamless workflow

into delivering pulsed field ablation.

Now, it's very easy to see exactly where the Volt is.

That proximity to that cardiac tissue, how important is that?

One of the specific advantages of the Volt system is

how it's a balloon-based technology

that allows us to have very good proximity to the heart.

So you can see on that image how that balloon is touching

the heart tissue, which prevents destruction

of red blood cells, which is very important

in certain patients, especially

patients who have kidney disease.

Now, you've talked a lot about the safety and efficiency

of a system like Volt.

What are some of the advantages that'll bring to --

to treating AFib going forward?

AFib is a growing problem.

It is probably one of the most common arrhythmias

in the globe.

And one of the things historically,

we've waited for patients to fail a medication.

And we've been very, very reactive in taking care of

these patients.

What I would envision for the future with technologies

like Volt is that we're able to take this to the patients

early on, be more proactive in their care,

and get this therapy to the patients early on

in their disease rather than wait till it progresses.

Well, Doctor, thank you very much.

-This has been great. -Absolutely, absolutely.

[George] Oh, hey, Dr. Tung!

You're here. Welcome to Inventionland.

-Good to see you again. -Good to see you as well.

I was looking forward to you coming in, because

I've had some, uh, reflections lately.

A really good friend of mine's wife had a heart situation

and they found her in a bad way,

but they got her back in order.

And I was hoping you could talk with me a little bit about,

you know, what is the best way I should be living my life

or what's the best way to go forward

and to keep good heart health?

This is the most common question

that we get as cardiologists.

And if you start with the basic,

which is just avoidance of toxins,

which not only is about cigarettes and alcohol,

but sugars and refined carbohydrates

and highly processed foods,

those are toxins as well.

But, really, there's this emphasis

on cardiometabolic health and earlier detection.

And when you think about conditions like

atrial fibrillation, it runs with obesity, being overweight,

where two out of three Americans are now, overweight.

So it's really being able to prevent some of that spiral

that occurs with diabetes, obesity,

and then, inflammatory states.

Atrial fibrillation used to be thought as just a nuisance.

Like, "Oh, I've got this irregular rhythm."

"Oh, grandma used to live in that."

But now we understand that it's a precursor to stroke.

It increases the risk of a stroke by five.

It increases the risk of heart failure by three.

So by being able to pick up on some electrical signals

in the heart, we might be able to predict if these things

could have been prevented, you know, down the road.

So...wearing a device,

eating more healthily, getting outside, whole foods,

that kind of thing.

OK, we can do a lot of that.

I was hoping you could project as well,

you know, where are we going in the future in this field?

Can you talk a little bit about tomorrow's world?

It will all be based on early detection

and easier, safer therapies.

So you can pick something up early,

but if you can't do anything about it,

it doesn't mean anything.

And if you've got a great therapy,

but you got problems detecting it,

doesn't mean anything.

So they're really tied hand-in-hand.

The early detection part,

which is all the different watches that can pick up

arrhythmias now. -Yes.

In the future, it will be on things

that you and I didn't expect.

It could be through facial recognition in a mirror.

It could be on standing on a scale.

So atrial fibrillation will be something

that could be picked up in the wild

and not in the office or in the hospital

when it's too late.

Then, if you have a therapy,

something like ablation that we do now,

which is just going in with the vein of the leg,

it's not surgical.

And with pulse field,

it's a lot safer and it's a lot faster.

This is something that can be done as a day procedure

and under an hour under some sedation.

So by being able to quiet down atrial fibrillation or even

eradicate it with a very minimally invasive therapy,

that will move the needle for longevity, reduction of stroke,

and heart failure. -That's amazing.

Mm-hmm.

Thank you for telling us a little more about

tomorrow's world. I really appreciate it.

Well, that's another edition of "Tomorrow's World Today."

So we have some new medical devices that we're working on

in Inventionland. -Mm-hmm.

I'd love to show you a few things.

-You good for that? -I would love it.

Come on, let's go down and we'll go into the lab.

[Greg] And remember, tomorrow's world is where inspiration

and creation drive innovation and production.

See you next time.