Atrial fibrillation (AFib) is not only the most common heart rhythm disorder, but it is also a growing epidemic globally.
With AFib associated with increasing age, Malaysia is especially vulnerable as we are already classified as an ageing nation.
AFib occurs when the electrical signals in the upper chambers of the heart become chaotic, causing the heart to beat irregularly.
It can result in significant disability, as well as death, due to the increased risk of stroke and heart failure in those who have it.
“We see atrial fibrillation across many areas of cardiology,” says National Heart Institute (better known by its Malay acronym IJN) Interventional Electrophysiology and Implantable Devices clinical director Datuk Dr Azlan Hussin.
“We see it in patients with heart failure, after heart surgery, and even in younger patients,” says the senior consultant cardiologist.
To improve treatment for such patients, IJN became the first hospital in Asia to clinically utilise an integrated electrophysiology platform to treat this condition.
This system not only combines advanced three-dimensional (3D) mapping technology and ablation capabilities to help electrophysiologists treat heart arrhythmias more efficiently, but also offers them the option of using either thermal radiofrequency energy or non-thermal pulsed field energy in a single device.
Plot and destroy
According to Dr Azlan, the system first builds a map of the heart as the catheter moves through the organ.
“It begins to collect information and create a visual map of what the atrium looks like,” he explains.
“This includes not only the condition of the heart tissue in the atrium, but also how fast electrical signals travel through the heart chambers.”
The images use different colours to indicate the condition of the heart tissue.
“You will notice colours such as red, purple and green,” he explains.
“Purple represents healthy areas of the heart, while red indicates scar tissue.”
In patients with AFib, these scarred areas often correspond to the regions where abnormal electrical signals originate.
By analysing these 3D colour-coded maps, doctors can pinpoint the exact areas that require treatment.
Once the heart tissue is mapped, doctors proceed to the next step: treatment via ablation.
This involves carefully destroying the abnormal tissue responsible for the irregular heart rhythm using either radiofrequency energy or non-thermal pulsed field energy.
With the new system, the same catheter is used for both mapping and to deliver treatment, says Dr Azlan.
This is in contrast with conventional systems where one catheter is used to map the heart and another to deliver the energy for ablation.
Using the same catheter throughout the process makes the procedure more efficient and may also reduce potential risks for the patient.
“Using this system, we were able to complete the procedure in about two hours,” he says.
“With the conventional set-up, the same procedure would typically take around four-and-a-half to five hours.”
During the ablation process, doctors carefully encircle and isolate the areas responsible for the abnormal electrical signals.
As the treatment progresses, the system marks the points where ablation has been delivered, allowing doctors to monitor the procedure in real time.
Once the ablation is completed, doctors repeat the mapping process to assess the results.
“We create a new map of the heart to see the effect of the treatment,” Dr Azlan says.
“After ablation, the tissue becomes more homogeneous, which means we will see fewer colours on the map.”
Who is suitable?
The system can generally be used for most types of AFib, but patient suitability still needs to be assessed carefully.
For example, individuals who have undergone previous heart surgery involving the implantation of a mechanical valve may not be right for the procedure.
“In those cases, interaction between the valve and the heart’s electrical system could make the procedure less suitable,” Dr Azlan explains.
Since February (2026), 11 patients have been treated successfully with this system at IJN.
The hospital currently uses several different ablation technologies, allowing doctors to choose the most appropriate system for each patient.
A significant number of AFib procedures are performed in IJN every year, reflecting the demand for treatment.
“In terms of ablation procedures for atrial fibrillation, we perform roughly 400 to 500 cases annually,” notes Dr Azlan.
“Looking ahead, the system is also being developed for use in the lower chambers of the heart, known as the ventricles, and is expected to become available in the next year to a year-and-a-half,” he says.
