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Heart Ablation the 2nd time around

Sep 18, 2008 - 3 comments

heart ablations



Hi, Im having a lot of SVT and AF lately, They have uped my Toprol from 50mg twice a day to 75 to 100 twice a day.
I have had Ablation done 4/22/05 and I am still on all this Toprol. My Dr keeps asking me to have it done again. My ?
about this is what if I have it done and it dosent work again. It worked about 75% and I can breath better now. Before I couldnt walk a cross Wal-Mart with out getting out of breath, so It did work some. Has any one els here ever had it done or had it done twice? It messed the bottem part of my leg up and I have permanent bad blood flow in it now.That night I had it done I had a complete heart block and lived passed it! I guess I am just scared and not sure about the whole thing again?????? If any one els has had it done please write me back please! Ablation of the heart and thinking about the second time around!!!!!!

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Avatar universal
by stoneabba, Jan 03, 2009
Many have to have it done to find the missed electrical pathways....check this site:

some good stories from others who had procedures

Avatar universal
by stoneabba, Jan 03, 2009
Cryoablation is safer?

Using Cryoablation to Treat Pediatric Patients: Interview
with Peggy Strieper, DO, Director of Pacing and
Electrophysiology at Sibley Heart Center of Children’s
Healthcare of Atlanta
- Interviewed by Jodie Miller

Cryoablation is making its way as the preferred technology in the
treatment of arrhythmias. Dr. Strieper, of Children’s Healthcare of Atlanta
(CHOA), recently began using the procedure in pediatric patients. In this
article, she describes the procedure and its success rates.
Briefly describe the cryoablation procedure. What are
the benefits of using cryo?
In standard ablation, we heat the tissue of an accessory
pathway or “short circuit” within the heart and kill those cells
so SVT cannot occur. The problem with doing radiofrequency
(RF) ablation is that when you go on, it is a permanent
damaging of the cells, and so we don’t use RF ablation in
places that are close to the AV node. Cryoablation, instead of heating the
tissue, cools the tissue. A benefit of cryoablation is that you can test the
spot first by cooling the tissue to -30 ºC. If you are in the correct spot, you
will eliminate the pathway. There will be evidence that you are in the right
spot, and you are not causing any harm such as complete heart block. The
next step is to drop the temperature a bit further to -70 ºC, which will
cause the permanent cell damage, and then you can perform the ablation.
In cryoablation, you are able to get rid of the pathway by cooling, but you
have a portion of the temperature curve in which things are still reversible,
so if you are causing heart block or some other complication occurs, you
can come off and things will reverse themselves.
How many patients have been treated so far at choa?
We just acquired this system about a month ago, so we have only done
five patients so far. However, in the coming week, we have another five
patients scheduled. We have been selectively choosing our patients,
because there are some limitations with cryo as well. In addition, we still
continue to use radiofrequency ablation for the majority of our patients;
we use cryoablation for the patients that we think would benefit from this,
including those that have a substrate closer to the AV node.
Have they all been pediatric cases?
Yes. We are a truly pediatric center, we treat very few adult patients. All of
our patients have been young — less than 18 years of age. On occasion we
have an adult congenital patient, but most of our patients are less than 18
years old.
I have heard about cryo being used in adult cases; is this the first
instance of cryo being used in pediatric patients?
No, there are some other centers that are doing it as well. Toronto Sick
Children's Hospital has been doing cryoablation for a couple of years — in
fact, they were one of the pilot sites. From my understanding, they have a
lot less stringent regulation for getting new technology in Canada than we
do in the United States. Actually, when we did our first five cryoablation
procedures, we had one of the pediatric cardiologists from Toronto Sick
Children's, Dr. Joel Kirsch, come down and walk us through the procedure
so that we would be comfortable with the process.
When was the first cryo case performed? Who was it performed on?
How is that patient doing today?
I don’t remember the exact date, but it was about four weeks ago, so not
very long ago. The patient was a little 8-year-old who had a tachycardia
that was not well controlled with medication. Her pathway was fairly close
to the AV node, which is the normal pacemaker within the heart. Since this
patient was hard to control on medication, she was also at higher risk for
an ablation procedure and for complications. We went ahead and offered
cryoablation, and everything went well.
What has the success rate been so far? What complications, if any,
have you seen in the cryo cases performed?
We have not had any complications with cryoablation in the first five
patients treated so far. My understanding is that the complication rate is
lower across the board because you do have reversability with cryo. There
are some limitations of the procedures — it is not for everybody — but it is
certainly beneficial in cases such as septal pathways where it is close to the
av node.
What cryoablation equipment is used at CHOA?
Instead of using a radiofrequency generator, the generator uses nitrous
oxide. The liquid nitrous oxide that goes in through a lumen in the catheter
is converted to a gaseous state at the tip when heat is removed from the
surrounding tissue. The nitrous oxide is then evacuated from the catheter.
The nitrous oxide does not leave the catheter or enter the body at all — it
stays within the closed circuit and gets pumped through. The equipment we
use is made by CryoCath.
How does cryoablation differ in pediatric cases versus adult cases?
Are there different risks? Is there different equipment?
The same equipment is used for both pediatric and adult cases. This is
actually one of the challenges we face in the field of pediatrics, because we
have to use the adult equipment and must adapt things for our pediatric
patients. The difference is that the patients we are going to use cryo on are
the kids that have either failed medicine or are having difficulties with their
medication, so these are kids that would really benefit from ablation,
especially because of where their pathways are located. Generally, with
standard techniques such as RF, we would not do the septal ablation and
continue medications. By offering cryoablation, we can limit the number of
times the patient has to come to the emergency room and the patient can
come off their medication.
How soon can you ablate in pediatric cases? Are there any age
There is no age limit, but for the most part, in any kind of ablation we don’t
perform these procedures on infants. Their hearts are still growing and
ablating will cause scar tissue to form in the heart, so we prefer for the
patient to be larger. Generally, we will start doing elective ablations at
approximately 20 kilograms (or about 50 pounds). There are times where a
child just isn’t tolerating medicines or is having a lot of breakthroughs, so
we may do smaller patients. If it is truly more elective, we will wait until
they are preteen or approximately 10–12 years of age. Therefore, it
depends on what problems the patient is having, how many medications
they have been on, how many visits to the er, etc.; there are a lot of
different reasons why we will go ahead with the ablation sooner or later,
depending on the situation.
Had you previously used radiofrequency ablation?
Yes, that is our standard method. Last year we performed 129
radiofrequency ablations on pediatric patients and had a very good success
rate. The only children we didn’t offer ablation to were kids that we felt had
pathways that were just too close to the av node. We have been using RF
since 1993 at CHOA.
What are some of the advantages of cryoablation versus
radiofrequency ablation? Do you expect cryoablation usage to
The main advantage is that we can treat kids that we normally wouldn’t
ablate because it would be too close to their av node — those kids have
gained the most benefit from cryoablation. You can use cryoablation for
other substrates and for varying locations of pathways, but I am not sure
there is going to be a whole lot of advantage to ablating those patients with
cryo. We have had such a good success rate with radiofrequency and we
know its long-term results on children. I expect we will continue to use
radiofrequency primarily, and then for those additional patients we will go
ahead and use cryo.
What advances do you hope to see in the coming years?
I think some of the other advances in electrophysiology that have come out
recently is biventicular pacing or cardiac resynchronization therapy. Once
again, this has been used on adults for the last number of years for
patients with cardiomyopathy. Pediatrics is always a little slower to follow
the technology for adult patients. We have recently started to utilize some
of these cardiac resynchronization devices and pacemakers in
cardiomyopathy patients that would otherwise go onto transplantation; we
also have had very good results with biventicular pacing. I think we are
going to learn a lot more about this on patient selection and timing.
Regarding ablation, I think we are going to see improvements in different
ablation techniques and mapping.
Is there anything else you would like to add?
I think we will keep learning as we use the cryoablation techniques more
and more. It will be interesting after we see these five patients this week —
these five in particular have been in the lab before and we haven’t been

Avatar universal
by sister mtt, Jan 04, 2009
Hi, I am 56 and was ablated on 4/22/05. It seem to have done its job for awhile and then it came back. I can breath better and I can walk faster now. It woked 75% they said.I was on 50 mg of toprol before and now I am up to 75mg twice a day. I have not had to have my heart stoped yet and Its not as often as it was, my svt/af ! My valve in my lower rt leg dosent work now, due to the ablation. I had a complete heart block the night I had it done, so I am scared about having it done again! I do pass out every now and then too! I was the first one they did with the cool-tip, at UAMS, Dr Merino Leonardi!
He is the Asst Professor there with RFP team. My meds control my SVT/Af until I get a big push of adrenaline, stress, embarrassment, or prevoked badly. I try very hard not to get up-set if I can help it! I live right so I dont drink much, Ever now and then I have 2 drinks in the hot tub, my fave ofcrouse! For the most part Its stress I am sure! If I dont take my meds on time I can tellit, it lets me know it about it! The thing is the meds send my heart down and my BP can still be up with it! If I take more meds for the BP I bottum out with it some times! It all seems to be a big circle with all this! So if you will mail me back and tell me what you think. I would like to hear more about the cryo going too if I my!

                                                                                  Thanks again,

                                                                              Mrs Townson

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