Frank Waddell always enjoyed bicycling the 1.6-mile round trip to the water near his home south of Charleston, where he would take in the views that make the South Carolina Lowcountry so beautiful.
Being outside is one of his favorite pastimes, along with singing songs and playing the guitar.
But in recent years, some of those leisurely journeys outside were marred by exhaustion. Walking or pedaling a short distance could leave him breathless. Instead of venturing out to see the towering oaks and wildlife near his home, he sat in his recliner. He didn’t feel like the same person who once entertained crowds of music fans with the songs he wrote.
After being diagnosed with atrial fibrillation or A-fib — a common condition marked by irregular heart rhythm — he visited a cardiac electrophysiologist at Roper St. Francis Healthcare and learned of new technology that could restore his normal heartbeat. Pulsed field ablation uses small pulses of electricity to get the heart back on track. It has proven safer than traditional thermal ablation treatments for A-fib and could help restore Waddell’s zest for enjoying the natural world and strumming his guitar.
This spring, a team at Roper St. Francis Healthcare became the first in South Carolina to use manufacturer Medtronic’s pulsed field ablation technology to treat Waddell’s A-fib.
“When I was in A-fib, I didn’t feel like doing anything. It made me feel aggravated and depressed,” Waddell, 74, said shortly after the procedure. “I couldn’t have been happier that this opportunity came at the right time. Everyone at Roper Hospital was so kind and professional, and I can’t wait to get back on my bike.”
As the region’s leader in heart rhythm treatment, Roper St. Francis Healthcare now offers this new ablation technique as an effective means of treating A-fib, which affects millions of Americans and raises patients’ risk of stroke five-fold. The team of electrophysiologists who treated Waddell have advanced training in the procedure that typically involves quicker, less complicated surgery than traditional methods.
Adopting such innovations is a key component of Roper St. Francis Healthcare’s Strategic Plan 2030, which aims to expand access to high-quality care throughout the Lowcountry.
Dr. Michael Field, an electrophysiologist with Roper St. Francis Physician Partners Carolina Arrhythmia, conducted the first procedure on Waddell.
“Most patients who are candidates for the traditional methods will be candidates for pulsed field ablation,” Dr. Field said. “We’re fortunate to have access to this amazing technology and offer this important treatment for a very common condition.”
The toll of A-Fib
A-fib is characterized by irregular, often rapid beating in the atria – the two upper chambers of the heart. These periods of abnormal beats come and go. They can be brief but grow lengthier over time.
While most people with A-fib are over 60 and the risk of developing A-fib increases with age, it can occur at any point in life. Symptoms include heart palpitations, dizziness, fatigue and shortness of breath.
With A-fib, the stakes are high. Because the heart isn’t pumping blood properly, patients with A-fib can develop blood clots. Those clots can block blood flow to the brain and trigger a stroke. A-fib causes 1 in 7 strokes suffered by Americans, and those strokes tend to be severe, according to the Centers for Disease Control and Prevention.
Blood thinners and other medications are often prescribed to patients to lessen the risk of strokes and heart failure.
Still, the condition is widely undertreated, and CDC data show that A-fib leads to more than 450,000 hospitalizations in the United States annually and contributes to nearly 160,00 deaths.
That’s why researchers have worked to develop new ways to tackle this potentially life-threatening condition.
Ins and outs of ablation
Catheter ablation was first employed as a treatment for A-fib more than 30 years ago, and the technique has evolved rapidly over recent years.
Ablation is a minimally invasive treatment for several different types of cardiac arrhythmias but most commonly A-fib. The physician inserts several small catheters — slender, flexible tubes — into a vein in the groin. Using a 3D mapping system, fluoroscopy and ultrasound imaging, these catheters are placed into the proper areas of the left atrium. Energy is then delivered to destroy small amounts of the heart tissue causing irregular rhythms. Traditional methods use either radiofrequency energy, which heats the tissue, or cryothermal energy, which freezes the tissue.
Another catheter is used during the procedure to map areas of the heart covered by the ablation. This offers a 3D graphical view on a screen of the procedure’s progress.
Patients often go home within 24 hours of the surgery.
While these ablation techniques are effective and safe, complications can arise if the hot or cold energy damages surrounding structures, such as the esophagus, veins or nerves.
Promise of pulsed field ablation
The use of electronic pulses — rather than thermal energy — has been under development since doctors first used catheter ablation.
Electrophysiologists at Roper St. Francis Healthcare kept a close eye on the progress of pulsed field ablation during clinical trials, knowing the great promise it held. Dr. Field also participated in one of the trials.
In December, Medtronic became the first manufacturer to gain approval from the U.S. Food and Drug Administration for its PulseSelect Pulsed Field Ablation System.
By then, Waddell already knew about it. He had seen YouTube videos about the ground-breaking new treatment for the heart condition he had been diagnosed with in 2021.
After years of taking medication and wearing a monitor that tracked his oxygen saturation and heart rhythm, Waddell jumped at the opportunity when Dr. Field offered him a chance to become one of the first South Carolinians to receive the new treatment.
Waddell had recently lost a childhood friend whose A-fib contributed to his death. He knew he had to do something about his condition.
“You feel fragile and always scared you’re going to go into A-fib,” he said. “I just never knew when I was going to feel really, really bad.”
Living with A-Fib
Waddell started writing songs and singing in the early 1970s, as war raged in Vietnam.
After a career in the Air Force that spanned 34 years, he retired and started playing folk, country and gospel music at venues and festivals throughout South Carolina.
Waddell’s music gigs slowed during the COVID-19 pandemic – around the time his adult daughter went back to college to study nursing. One day in 2021, his daughter saw a photo of him singing at a festival, and she noticed his ankles. They were swollen, and she worried it could be a sign of an underlying medical condition.
Initially, Waddell brushed it off as a symptom of old walking shoes. He bought a new pair, but his ankles didn’t improve. He scheduled an appointment with his doctor.
One electrocardiogram later, and Waddell was diagnosed with A-fib. The diagnosis explained why shortness of breath and fatigue often robbed him of his walks or bike rides from his St. Helena Island home to the water, where he would take in the expansive views of Hilton Head Island and Parris Island – the stretch of Lowcountry known as the Marine Corps training ground.
In the months that followed, Waddell underwent electrical cardioversion, a procedure that delivers mild shocks externally to normalize his heartbeat, and took blood thinners. He saw the treatments as more of a Band-Aid than a solution.
His irregular heartbeat wouldn’t properly empty blood from his heart. He learned that the condition could cause pooling of that blood, triggering a clot and possibly a stroke.
“It was kind of like having a headache; it would bother me when I was in A-fib, but it would eventually go away,” he said. “But I knew something was wrong, and it wasn’t going away forever.”
‘A new light’
While visiting his cardiologist late last year, Waddell’s heart slipped into A-fib, exhibiting the symptoms that had hampered his lifestyle.
After listening to Waddell’s chaotic heartbeat, the physician recommended ablation and referred him to Dr. Field at Roper St. Francis Healthcare. Waddell knew he would be in good hands: His granddaughter is a nurse, and his daughter was studying to become one; they knew Roper St. Francis Healthcare’s reputation for top-notch cardiac care.
Waddell had already researched pulsed field ablation and quickly accepted Dr. Field’s offer to become the first patient in South Carolina to have the procedure using Medtronic’s technology.
The much-anticipated day came in early March in the cardiac catheterization lab at Roper Hospital in downtown Charleston.
With Waddell under general anesthesia, Dr. Field guided the Medtronic PulseSelect catheter to the atrial chambers of his heart. On a large screen, fluoroscopy tracked the catheter’s travel, and ultrasound depicted Waddell’s beating heart.
Once Dr. Field maneuvered the end of the catheter inside the atrium, he used a controller to expand the Medtronic probe, resembling a cardioid-shaped wire — similar to a conventional heart symbol. On that wire were nine electrodes, and once properly positioned along the atrium wall, Dr. Field gave a command. A team member in the operating room pressed buttons on a generator that delivered the first pulse to Waddell’s heart.
“It’s gone,” Dr. Field announced in the operating room. “Just like that.”
The physician was referring to pulmonary vein potentials, a term for the signals emitted by the veins that carry oxygen-rich blood from the lungs to the heart’s left atrium. Irregularity of these signals contributes to A-fib.
Seeing this sort of result would take at least 30 minutes of ablation with traditional techniques.
The speedy feedback was astounding.
“It’s amazing to see,” Dr. Field said. “It’s a smooth and quick procedure. Most importantly, it’s safe. I was able to ablate right next to the esophagus without concern of collateral damage.”
All told, Dr. Field ablated 64 areas of Waddell’s heart. The mapping probe, which runs to the heart through a second catheter, created a graphic on a large screen that showed Waddell’s atria lined in green, the color denoting the ablated areas.
Waddell was moved out of the operating room, making way for the patient second in line for the procedure that day.
Determining the long-term effectiveness of the ablation can take three to six months. But for now, Waddell said he already feels revitalized. The incisions healed quickly, and his heart has stayed in proper rhythm.
His biggest concern about resuming those bike rides? One of his tires was flat.
But Waddell said he would get it fixed, and he looks forward to living life: watching his daughter go to work as a nurse at Roper Hospital, the same facility where he had the procedure; taking his walks and bike rides; singing a song or two.
It’s a new day, he said. And it’s a new chapter in his life, mirroring the outlook of a character in one of his songs. The lyrics portray a man stepping onto his porch with a cup of coffee in hand. Rays of sunshine strike his face. The song continues:
There’s a new light shining down on me this morning, and I know it’s going to be a brighter day.
With the darkness and hard times far behind me,
In the new light, I can now see my way.