All language subtitles for Tomorrows.World.Today.S10E01.1080p.WEB.h264-CBFM_track3_[eng]

[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.