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Cryo Balloon Ablation

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The image illustrates the Cryo Balloon Ablation procedure.
Image Credit: medtronic.com
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Cryo Balloon Ablation ‑ An Overview

Cryo Catheter ablation is an innovative medical procedure that harnesses the power of extremely cold gas to freeze and eliminate abnormal cells. It is highly effective in treating PSVT (Paroxysmal Supraventricular Tachycardia) and other related conditions. This state-of-the-art technique offers a safer and less intrusive alternative to conventional RF Ablation.

One such application is Cryo Balloon ablation, a form of catheter ablation specifically designed to address irregular heartbeats caused by problematic heart tissue. Unlike traditional heat-based methods, the Cryo Balloon ablation procedure employs freezing energy to precisely disable the tissue responsible for irregular heart rhythms, particularly in cases of paroxysmal atrial fibrillation (PAF), where symptoms occur intermittently.

With its unique balloon design, this procedure enables the treatment of larger tissue areas simultaneously, simplifying the process and enhancing its overall effectiveness.

If you or a loved one are seeking the most advanced and reliable treatment for PSVT, AFib, or related conditions, Dr. Karthigesan is a leading expert in Cryo Catheter ablation. With vast experience and a dedication to patient care, Dr. Karthigesan is committed to providing the best possible outcomes for your cardiac health. Trust in his expertise to deliver exceptional results and a healthier heart.

The image illustrates the Cryo Balloon Ablation procedure of the pulmonary vein.
Image Credit: nejm.org
The image of the real-time Cryo Balloon Ablation procedure.
Image Credit: researchgate.net

Cryo Balloon Ablation: Arrhythmias Treated

Cryo Balloon or Cryo Catheter Ablation is a highly effective and advanced treatment method utilised to address various types of arrhythmias. It proves to be particularly suitable for cases of Atrial Fibrillation (AF) when medications and other treatments have not successfully restored the heart to a normal rhythm. Moreover, this innovative procedure is employed to treat the following heart conditions:

  • Supraventricular Tachycardias (SVTs)
  • Ventricular Arrhythmias
  • Atrial Flutter
  • Atrial Fibrillation

The Evaluation Process: Cryo Balloon Ablation Procedure

To ensure the most suitable and effective treatment plan, Dr. Karthigesan may recommend additional tests to gain a deeper understanding of your heart condition and its impact on your health. These essential diagnostic assessments may include:

  • Blood Test
  • Chest X-ray
  • CT or MRI Scans
  • Echocardiogram
  • Transesophageal Echocardiogram (TEE)
  • Electrocardiogram (ECG)
The image of the Arctic Front cryoablation catheter.
Image Credit: consultqd.clevelandclinic.org
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The image illustrates the Cryo Balloon Ablation procedure with the catheter.
Image Credit: europe.medtronic.com

The Cryo Balloon Ablation: Procedure

  • Cryoablation prevents unwanted electrical signals from travelling between the pulmonary veins and the atria, targeting the tissue where these connections occur. This technique is known as pulmonary vein isolation. 
  • The procedure involves making a prick in the groin area to insert a catheter. The catheter is guided to your heart using advanced imaging techniques.
  • Dr. Karthigesan will then navigate through thin tissue to access the pulmonary veins with the cryo balloon, which is then inflated and positioned at the opening of the pulmonary vein.
  • By maintaining contact and achieving occlusion, the cryo balloon reaches a sufficiently cold temperature to create a scar at the vein's opening, effectively stopping the transmission of abnormal electrical signals.
  • The entire procedure typically takes one to two hours, thereby offering comfort, convenience, and a precise and efficient treatment option.

What to Expect Before / During / After the Procedure

  • Inform Dr. Karthigesan about any allergies or existing health conditions you may have.
  • Abstain from eating or drinking anything on the night before the procedure.
  • Consult with Dr. Karthigesan five days before the procedure to discuss medication adjustments and potential discontinuation requirements.
  • You may be advised to temporarily discontinue specific medications, such as blood thinners.
  • Dr Karthigesan will administer local anaesthesia in your groin. This way, you will not feel any pain when inserting the catheter since the area will be desensitised.
  • If necessary, a mild sedative will be administered through an intravenous line(IV).
  • The procedure is started by making a small keyhole in your groin area. The catheter will be inserted through that.
  • The catheters are used to record your heart's electrical activity. It also emits electrical impulses to pinpoint the abnormal tissue responsible for your arrhythmias.
  • Once identified, the next step involves creating small scars using a cryoballoon.
  • ​​The cryo-balloon is carefully inflated with a specialised gas coolant precisely at the opening of the pulmonary vein.
  • This inflation creates a circular scar, thereby separating the triggers of atrial fibrillation (AFib) from the rest of the atrium.
  • As the cryo-balloon comes into contact with the tissue, it induces scarring, which disrupts the propagation of AFib-causing electrical currents.
  • The catheters will be removed, and you will be moved to a separate room to be monitored.
  • You will be asked to take rest for 1 or 2 hours, and after that, you can go back home.
  • Make sure that you do not involve yourself in any strenuous activities for a few days after the procedure.

Top Benefits of Cryo Balloon Ablation

  • Cryocatheters, both focal and balloon-based, adhere to the tissue, minimising movement during the procedure. This stability is particularly advantageous when ablating in delicate positions.
  • Cryo-ablation can decrease the risk of stroke by eliminating the primary cause of blood pooling in the left atrial appendage.
  • Patients will be able to discontinue or reduce their medication therapy, leading to fewer side effects and improved overall well-being.
  • As a minimally invasive procedure without surgery, you will experience a quick recovery, often within just a few hours.
  • Cryo balloon ablation allows for a preview of its effectiveness by partially lowering the temperature before performing the full ablation, providing valuable insights for optimal results.
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Cryo Balloon Ablation - Answers to Your Questions

Cryo balloon ablation is a type of catheter ablation that uses cryo, or freezing, energy to disable heart tissue causing irregular heartbeats. Cryo balloon ablation success rate is around 85% for paroxysmal Atrial fibrillation.

This keyhole procedure is done under IV anaesthesia and by inserting a Cryo balloon catheter from the groin into the left atrium and electrically isolating all 4 pulmonary veins. The entire Cryo balloon ablation procedure may take 90 mins on average.

Heat-Based Ablation (Radiofrequency Ablation):

  • Most commonly used method for ablation, employing radiofrequency (RF) catheters.
  • Involves delivering heat energy to the targeted tissue to disable abnormal heart cells causing arrhythmias.

Cryoablation:

  • Utilises extremely cold temperatures to disable abnormal heart tissue.
  • Avoids the risks of complications linked to heat-based ablation by using cold instead.
  • Offers the unique advantage of cooling tissue to confirm if it is the source of irregularities; if not, the tissue can be allowed to thaw and re-warm, restoring its normal electrical function.
  • Cryo Catheter Ablation:

Cryo Catheter Ablation involves using a specialised catheter with a tip to deliver extremely cold temperatures and freeze and destroy targeted tissue, causing arrhythmias. It can be used to address specific areas of the heart where abnormal electrical signals originate beyond the pulmonary veins. Cryo Catheter Ablation is used for treating PSVT conditions.

  • Cryo Balloon Ablation:

Cryo Balloon Ablation is a specific type of Cryo Catheter Ablation. It employs a catheter with a balloon-like structure at the tip, filled with a freezing liquid. This catheter is guided to the opening of the pulmonary veins in the left atrium of the heart, where the cryo-balloon is inflated to create a circular scar. It is primarily used to treat atrial fibrillation (AF) by targeting the pulmonary veins, which are a common source of abnormal electrical signals in this condition.

Advantages:

  • Ability to perform "site testing" or "cryo mapping" before permanently disabling tissue, allowing for adjustments if needed.
  • Cryo catheters adhere tightly to the target area, minimising movement during the procedure, unlike RF catheters.
  • Effective in areas of reduced blood flow.

The success rate of Cryoablation for Atrial Fibrillation is generally high. However, outcomes can be influenced by many factors, including duration of atrial fibrillation, cardiac disease (valve or coronary), atrial fibrillation type (paroxysmal or persistent), and atria size.

Like any medical procedure, there is a rare possibility of complications. These include stroke, perforation of the heart, heart attack, bleeding from the entry site in the leg, or pulmonary vein narrowing. However, overall, Cryoablation remains a safe and effective option for treating atrial fibrillation and restoring heart rhythm in many patients.

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