By Ansley Franco
This April, William Maddox, MD, an electrophysiologist at the University of Alabama at Birmingham, was the first physician in Alabama to perform a pulsed field ablation (PFA). Access to new technology like the Affera Mapping and Ablation System for atrial fibrillation is why Maddox was drawn to UAB.
“At UAB, we strive to make the therapy that’s offered to our patients safer, more effective, and for us more efficient. This is why I’m here: to be able to work on these technologies and offer them to our patients,” Maddox said.
Atrial fibrillation, the most common sustained cardiac arrhythmia, affects millions of Americans annually. According to a 2024 study by the University of California San Francisco, A-fib affects nearly five percent of the U.S. population or about 10.5 million adults. The condition is associated with increased risks of stroke, heart failure and diminished quality of life.
Traditional treatment for A-fib includes medication, lifestyle modification and catheter ablation. Historically, ablation has relied on thermal energy, either in the form of heat or cold. While effective, these techniques can cause collateral damage to the surrounding tissues, including the esophagus and phrenic nerve, and in rare cases, lead to atrial-esophageal fistula, a complication with a high fatality rate.
“We’ve long been looking for ways to continue to be effective in our ablation, but to mitigate those possible complications. They’re quite rare even with using radiofrequency (RF), but we would like to make things 100 percent safe, which is almost an impossibility in medicine, but we continue to strive to be there,” Maddox said.
The Affera system, developed by Medtronic, integrates high-density cardiac mapping with both pulsed field and radiofrequency ablation in a single catheter. Data has shown that the procedure has nearly zero risk of atrial esophageal fistula and phrenic nerve injury. Unlike traditional thermal ablation, PFA uses high-voltage electric fields to induce cell death without the need for heat or cold. This significantly reduces the risk of damage to non-cardiac tissues.
The first procedure was conducted on a patient who had long-standing persistent atrial fibrillation that had been going on for about six or seven months who was quite symptomatic. “We were able to do the ablation, and the patient left the hospital with a normal rhythm, and they have been doing well since,” Maddox said. “The fact that the mapping system and the ablation system is all in one unit makes it a very easy system to adopt.”
Maddox, who serves as medical director of the EP lab at UAB, performs more than 1,500 procedures annually, about 80 percent of which are ablations. In just a few weeks, UAB’s electrophysiology team has completed 74 procedures with the Affera system without any significant complications.
The early data on PFA using the Affera system supports this observation. Studies and early clinical trials suggest that the technology offers comparable efficacy to traditional ablation with significantly fewer complications. While recovery times remain similar, Maddox said patients have reported reduced chest pain following PFA procedures, likely due to the tissue-selective nature of the treatment.
Maddox’s path to medicine was anything but linear. Originally a history major and an avid cyclist, he found his calling after a cycling friend invited him to observe a neurosurgery case at age 19. That experience led him to switch his major to exercise physiology. Eventually, he discovered a deep passion for internal medicine and later, for the intricate physiology of the heart.
“The heart is beautiful and simplistic in his design, but then also the nuances of it are very complex. And I like the duality there a bit and felt that it was so fascinating,” Maddox said. “
His interest in electrophysiology was solidified during his first few days in the EP lab when he witnessed a dramatic ventricular tachycardia ablation. From that point forward, Maddox committed himself to not only performing cutting-edge procedures but also helping to bring them to patients as safely and effectively as possible.