Aa
Cryoablation
I've had two ep studies/ablations done. The first in December 2000 and the second in July 2001 using the carto mapping system. My tachycardia returned 1 to 2 weeks after, both times. My ep doctor said that the fast rhythm originates in the sinus node (IST?) and he was concerned that if he modifies the sinus node I will end up with a pacemaker. I am currently on sotalol 80 mg every 12 hours and toprol xl 100 mg daily to slow my heart rate which is constantly fast. Based on an echocardiagram my ep doctor told me that my heart is enlarged from the tachycardia and I must take medication to prevent further enlargement and heart failure. Toprol xl was recently added because I started having chest pain and sob when exercising. Thallium stress test was normal except for fast heart rate.
My question is, has cryoablation advanced to the point that it can safely be used to ablate in the sinus node of the heart? I noticed that the "Freezor" was approved by the FDA in April 2003 for.
The side effects of medication make it difficult for me to function in my job as a college counselor. I'm also working on a graduate degree and the medication makes that difficult also. I've had to take a break from my research because I just don't feel well enough to continue. I'm starting to think a pacemaker would be better than all these meds. By the way, I'm female, in my 40's, otherwise healthy. Meds are: sotalol,toprol xl, zocor, lasix,and aspirin. Family history of early heart disease.
Thanks in advance for any advice or assistance.
My question is, has cryoablation advanced to the point that it can safely be used to ablate in the sinus node of the heart? I noticed that the "Freezor" was approved by the FDA in April 2003 for.
The side effects of medication make it difficult for me to function in my job as a college counselor. I'm also working on a graduate degree and the medication makes that difficult also. I've had to take a break from my research because I just don't feel well enough to continue. I'm starting to think a pacemaker would be better than all these meds. By the way, I'm female, in my 40's, otherwise healthy. Meds are: sotalol,toprol xl, zocor, lasix,and aspirin. Family history of early heart disease.
Thanks in advance for any advice or assistance.
I was given heparin during my most recent (2nd) ep/ ablation and continued on aspirin 325 mg daily post procedure.
I am by no means an expert on the subject of complications arising from rf ablation, however, I can say that the major complications include stroke and stenosis of the pulmonary vein.
Both of these arise from the heating caused by the rf within the atrium-pulmonary vein region. Clots which could form and break off could lead to stroke, and the edema which results from the trauma can cause the pulmonary vein connection to swell up and restrict blood flow. Methods used today are designed to minimize the chance of either of these to occur. Typical risk at a large institution runs at about 1-2%, maybe less, and often dependent upon the individual's specific situation. I was more worried about the clot dislodging from the catheter insertion point (in the groin) than anything else.
I don't recall receiving any blood thinner prior to the rf ablation procedure...I guess it's a balance, since you do want the catheter insertion points to heal up, which requires clotting. By the way, the PV edema is generally minor, and generally quite reversible.
The risk of ablating a portion of the AV node totally depends on where they do the cooking. I am sure your EP will tell you what that risk will be. In my case, the trouble-making foci were in the PV ostia, well away from the AV node.
You should be able to get a solid figure for the risk of complications from your EP, and if you don't, demand it before agreeing to the procedure. Like I said, the risk is likely to be quite small.
-Arthur
Both of these arise from the heating caused by the rf within the atrium-pulmonary vein region. Clots which could form and break off could lead to stroke, and the edema which results from the trauma can cause the pulmonary vein connection to swell up and restrict blood flow. Methods used today are designed to minimize the chance of either of these to occur. Typical risk at a large institution runs at about 1-2%, maybe less, and often dependent upon the individual's specific situation. I was more worried about the clot dislodging from the catheter insertion point (in the groin) than anything else.
I don't recall receiving any blood thinner prior to the rf ablation procedure...I guess it's a balance, since you do want the catheter insertion points to heal up, which requires clotting. By the way, the PV edema is generally minor, and generally quite reversible.
The risk of ablating a portion of the AV node totally depends on where they do the cooking. I am sure your EP will tell you what that risk will be. In my case, the trouble-making foci were in the PV ostia, well away from the AV node.
You should be able to get a solid figure for the risk of complications from your EP, and if you don't, demand it before agreeing to the procedure. Like I said, the risk is likely to be quite small.
-Arthur
Thanks so much. I'll have to see if my insurance will go for that. The Cleveland Clinic would be my first choice. Is Dr. Natale still the expert in sinus node modification? I know he was recommended to me at one time.
You seem quite knowledgeable on the subject of ablation and I know that you had one done. I read one of your posts about complications of blood clots. Does the blood clot risk exist during the procedure and/or for some time after and how bad is that risk? Do they give a blood thinner prior to ablation to avoid the problem? I cannot seem to find much info on the subject. Also, do you think I am just reading way to much into this as I have some fears of the related complications with ablation. From what I've read there seem to be a number of them including the risk of ablating too close to the AV node and then having a pacemaker. Did you have some of these fears prior to your ablation? Thanks in advance for responding.
Glassheart46 (Mary)
Glassheart46 (Mary)
Consider second opinion here (Cleveland Clinic) or Mayo. The western clinics have less to offer in this regard.
I am in the Western United States
Neener99,
Thanks for the post.
The key to a successful ablation is to have the right combination of operator and equipment. A good operator with bad equipment is what you'll find in third world countries, while a bad operator with good equipment can be found in most any hospital in the US.
My point is that I think a good operator can ablate your AV node with or without cryo. The operator needs to be skilled enough to ablate the upper portion of the sinus node, where the fast pulses originate, but not near the lower portions. However, even a skilled operator will carry a 5-10% chance of inducing sinus node damage, which would then necessitate a pacemaker. These numbers will not be changed by cryoablation technology.
Seek counsel with an expert at a tertiary referral center. I would only have this procedure done at one of a few centers: Cleveland Clinic, Johns Hopkins, Mayo, Michigan, Mass General, UCSF, Indianapolis (Prystowsky or Zipes), plus a couple of others.
Post the region where you live, if you want, and I can provide some guidance.
Lastly, given the disability you describe, you may wish to proceed. You might actually feel better with a pacemaker.
Hope that helps.
Thanks for the post.
The key to a successful ablation is to have the right combination of operator and equipment. A good operator with bad equipment is what you'll find in third world countries, while a bad operator with good equipment can be found in most any hospital in the US.
My point is that I think a good operator can ablate your AV node with or without cryo. The operator needs to be skilled enough to ablate the upper portion of the sinus node, where the fast pulses originate, but not near the lower portions. However, even a skilled operator will carry a 5-10% chance of inducing sinus node damage, which would then necessitate a pacemaker. These numbers will not be changed by cryoablation technology.
Seek counsel with an expert at a tertiary referral center. I would only have this procedure done at one of a few centers: Cleveland Clinic, Johns Hopkins, Mayo, Michigan, Mass General, UCSF, Indianapolis (Prystowsky or Zipes), plus a couple of others.
Post the region where you live, if you want, and I can provide some guidance.
Lastly, given the disability you describe, you may wish to proceed. You might actually feel better with a pacemaker.
Hope that helps.
Just a quick comment, as I have checked out cryoablation previously...it would appear that the early reports of its success may be overstated. It does provide a nice way to "temporarily ablate" focal regions to test the location in order to avoid ablating pacemaker regions before really zapping the area with extreme cold. However, I have heard that many such treatments are turning out to be too reversible, ie, the ablated foci have a chance of reviving...making the procedure of questionable value.
-Arthur
-Arthur
Thanks, Arthur. I'll be sure to ask my doctor if he thinks there's a chance of success with cryoablation. I doubt that he would even put me through it if he doesn't feel it will be successful. Guess I'm just getting kind of desparate. Tired of having recurring problems and can't imagine being on these drugs for the next 20 to 30 years.
By the way, since they added the toprol xl to my other meds my blood pressure has actually gone up instead of down. Now 150/100?? Not sure what's up. You would think with all the meds I'm on my blood pressure could not be high. I think I'll give my doctor a call tomorrow.
Do you happen to know if any hospitals in or near Utah have the facilities to do cryoablation?
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