PROVIDENCE — Rhode Island Hospital is the only site in New England using artificial intelligence to treat atrial fibrillation, a heart condition that causes irregular heart rhythms.
The hospital partnered with Providence-based Volta Medical to use the company’s VX1 AI software as part of an international study led by Volta. Their VX1 is a specialized software solution that “can only function with cutting-edge cardiac mapping and recording systems,” according to the company.
Atrial fibrillation, also known as “A-fib,” is an irregular and sometimes very rapid heart rhythm. It can lead to blood clots in the heart, but also increase the risk of strokes and heart failure.
Q: A-fib is expected to affect 12.1 million patients in the US by 2030, according to researchers at Volta. How many are in Rhode Island now?
Philbin: Atrial fibrillation is the most common disorder of heart rhythm. The worldwide prevalence of atrial fibrillation is 0.51 percent. The US census estimates Rhode Island’s current population at 1,095,610. The math therefore suggests that there are about 5,600 people in the state currently in atrial fibrillation. Between 2016 and 2021, Rhode Island Hospital performed 671 atrial fibrillation ablations.
I think it’s been hard for primary care physicians [and others] to keep up. I think that it’s more clear [to the industry] that managing with medications is not enough, and that we can do better. But frankly, addressing A-fib is a huge part of maintaining population health in Rhode Island.
[According to the Rhode Island Department of Health’s Hospital Discharge Data, paroxysmal and/or unspecified A-fib accounted for 1,312 emergency room visits and 790 hospitalizations in 2020 alone (the most recent data available).]
What are some of the symptoms of A-fib?
One of the interesting things about the rhythm is the broad way it presents. It affects people very differently and falls into three groups. One group knows right away when they are in A-fib because they feel horrible, they have unpleasant rapid heart rhythm, palpitations, and don’t want to get out of bed. That person will be seen quickly. On the other end of the spectrum, there are many that are unaware of being in it at all.
Are there any triggers?
Alcohol — including even moderate drinking over the long term, sedentary lifestyle and inactivity, and sleep-disordered breathing [such as sleep apnea].
Does everyone with A-fib need to undergo a procedure?
When a patient has paroxysmal atrial fibrillation, which is usually relatively early in the onset of it happening, [the rapid rhythm] tends to come and go on its own. Once the rhythm has been there for longer — the spells get longer, closer together, and then becomes persistent — it won’t stop on its own unless somebody does something to it. The procedure to treat atrial fibrillation is an ablation.
However, what this software is targeting is this group of patients whose A-fib has become persistent. It starts and stays for more than a couple of weeks. That person’s success rate for an ablation gets much smaller. It has become a real challenge to deal with because by the time a lot of people come to us, their A-fib is persistent.
How does the VX1 AI software work?
The Volta software relies on a massive library of electrograms that have been taken from thousands of successful ablation procedures... that put the patient back into normal rhythm. The Volta software analyzes the electrograms around the left atrium and finds other targets to ablate to increase the likelihood of success. In real time, the algorithm analyzes... and says ‘OK, this looks like a success site’ and tags it for me so I can see it on a very sophisticated anatomic map.
By using the software, I can go around and find all the other places that may be drivers for the A-fib, and then use that to do more ablation to try to put the patient back into [a regular] rhythm.
Are there risks?
We are doing more ablating so the procedure length could potentially be a little longer. But in our experience so far, we have not had any adverse events related to the software since it’s just allowing us to do what we already do in a more directed way. We are hoping, in theory, that using this software is actually less risky since the ablation will be tailored rather than just anatomically driven.
How has Lifespan’s Cardiovascular Institute changed since you arrived?
I joined the practice here in October 2020. At the time, there were two arrhythmia specialists and now we have five. We’re building a brand new, state-of-the-art EP [electrophysiology] laboratory, which is the place where we manage cardiac arrhythmia. We are developing what was already a well recognized heart rhythm program into a more innovative, world-class center.
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