Atrial fibrillation is one of the most common complications of the heartbeat’s rate/rhythm. It is primarily caused by disorganized signals in your heart. However, there are other causes, such as heart valve problems, high blood pressure, heart attack, previous heart surgery, and lung diseases, to name a few. When left untreated, atrial fibrillation gets worse over time.
Numerous medications and procedures can be utilized to treat atrial fibrillation. Most of these techniques do not provide substantial medical results to some patients. Cryoablation has proven to be one of the most effective techniques for treating atrial fibrillation. This is because cryoablation for AFib distorts the tissue causing unpredictable electrical signals and preventing erratic signals from reaching the atria.
It is also an advantageous procedure because it is less invasive, and patients experience less pain than radiofrequency ablation. In this article, we have discussed everything you need to know about cryoablation for atrial fibrillation, how it is performed, its effectiveness, and possible complications.
What Is Atrial Fibrillation?
Atrial fibrillation is a condition where the damage to the heart’s electrical system causes the two heart chambers to squeeze very fast. This causes irregular and rapid heartbeats. Although the condition does not have clear symptoms, it is advisable to seek a medical diagnosis when you feel fatigued, have shortness of breath, and have palpitations. Atrial fibrillation can be treated using various methods such as drugs, cardioversion (electrical shock), and surgical ablation procedure.
Causes of Atrial Fibrillation
The main cause of atrial fibrillation is disorganized electrical signals, but the condition may also be attributed to other factors such as:
- Genes- There are high chances that you can get AFib from your parents as it is a hereditary condition. In addition, if any other close family member has AFib, you have a high risk.
- Age- As senility approaches, there are high chances of developing various heart-related complications. Heart diseases and related conditions are the major causes of atrial fibrillation.
- Heart complications- AFib is a complication of the heart which means that other heart problems may increase the chances of developing the condition. Such heart problems include heart valve disease, coronary artery disease, heart failure, weakened heart muscle, heart attack, and heart birth defects.
- Sick sinus syndrome- Your heartbeat is controlled by a group of cells known as the sinus node. Complications of the sinus node, such as misfire of the heart’s electrical signals and when the heart rate switches from fast to slow abruptly, can cause AFib.
- Heart Surgery- Atrial fibrillation is a common condition for people recovering from heart surgery. According to various studies, AFib happens to 2 or 3 people out of 10 who have undergone heart surgery.
- Lung disease- Various types of lung diseases such as emphysema, pulmonary embolism, or chronic obstructive pulmonary disease are prominent causes of AFib.
Basically, cryoablation is the process conducted to distort the heart cells that cause irregular heartbeats and rhythms. The process is executed by an electrophysiologist (EP doctor), and cryoablation began about a decade ago.
Cryoablation involves restoring the normal heart rhythm and involves a minimally invasive procedure. An EP doctor utilizes a thin, flexible tube called a balloon catheter. The tube helps in locating and freezing the heart tissue causing irregular heartbeats. Cryoablation uses extremely cold gas to freeze and dismantle the tissues causing AFib. The procedure is advantageous because it is safer and less invasive than surgery. It is also utilized in skin disorders and cancer, among other conditions.
How Is Cryoablation Executed?
An EP doctor inserts the balloon catheter in a blood vessel, mainly in the upper leg, and channels it until it reaches the heart. The inflatable balloon helps in engaging the pulmonary vein. With the help of advanced imaging techniques, the EP doctor guides the catheter to the heart, flows extremely cold gas through the catheter, and distorts the tissue causing irregular heart rhythms. The procedure takes about one to two hours.
Before the procedure is executed, numerous tests such as blood tests and an electrocardiogram must be performed. It is also advisable that patients should not eat or drink anything 8 hours before cryoablation. Patients should also consult with the EP to advise on whether they should stop taking any medications.
After the procedure is complete, the catheter is removed, and patients are observed in a monitored unit. The observation can be performed overnight to confirm the patient’s heart condition. If they are okay by morning, they can be released.
The Difference Between Cryoablation and Heat-Based Ablation
Also known as radiofrequency ablation, heat-based ablation is a type of catheter ablation that utilizes energy similar to microwave heat. This is as opposed to cryoablation, where extreme cold gas is utilized in the procedure.
Heat-based ablation has been used on numerous patients as it has been utilized for a longer duration compared to cryoablation. Moreover, the FDA approved the second cryoablation catheter in August 2012. In radiofrequency ablation (RFA), heat is transferred from an alternating current to the ablation zone. Cryoablation has advanced in recent years, making it more adopted than RFA in treating various conditions.
RFA has numerous risks and complications, such as it can only be used on a small area, while the balloon in cryoablation covers even the large tissues. Using cold rather than heat in surgical ablation procedure is the best technique as it helps the doctor determine whether that’s the specific area of concern before permanently disabling the tissue.
If the EP later discovers that the area disabled was not the main cause of atrial fibrillation, they can warm up the area to return to normal function. When heat atrial fibrillation ablation is used, there is no reverse procedure. In addition, cold atrial fibrillation ablation ensures that other healthy heart tissues and nearby organs are not affected during the procedure. Research has proven that cryoablation is more effective than RFA, and patients experience less pain during the procedure.
The Success Rate of Cryoablation
Despite the inception of cryoablation in recent years compared to RFA, the procedure has proven to be powerful. It has gained widespread usage in recent years, and according to Oxford Academic, cryoablation has a success rate of 70 – 80% for the first procedure. However, various factors influence the efficacy of cryoablation procedures, such as:
- Size of the atria
- Duration of the condition
- Type of atrial fibrillation (persistent or paroxysmal)
- Presence of valve or coronary artery disease
Cryoablation has been highly adopted as an alternative to RFA because cooling mitigates some risks that come with thermal ablation. For instance, cryoablation does not have the risk of overheating the tissues, cardiac perforation, and a reduction in steam pops. Although cryoablation has a success rate of between 70 – 80%, characteristics such as the variants of PV anatomy can influence the procedure’s effectiveness.
A mismatch in the diameter between the cryoballoon and the PV can have negative results in the procedure. This is because there will be no sufficient contact with the tissue. Also, note that women have a lower prevalence of atrial fibrillation than men. Thus, gender also plays an important role in response to cryoablation procedures.
The first description of the efficacy of cryoablation was reported in 2003 when 29 out of 52 patients (56%) were treated and found not to have recurring AFib. A decade later, improvements were performed to the refrigerant delivery system. A meta-analysis was conducted on 2363 patients and recorded an 83% success rate on paroxysmal AFib and a 70% success rate on persistent AFib. These statistics were recorded one year after the procedure, proving that cryoablation is more effective than its predecessor, RFA.
In addition, cryoablation procedures have fewer relapses than medications and other procedures. Cryoablation has a lower risk as it utilizes extreme cold, which does not have adverse effects compared to heat. Hence, there are lower chances of cardiac tamponade and pericardial effusion. The doctor will also scrutinize a patient to determine whether any pre-existing conditions may affect the efficacy of cryoablation.
Does Cryoablation Have Any Complications
Though cryoablation is safer and more effective compared to medications, RFA, and other techniques, there are still some complications. They include:
- Narrowing of the pulmonary vein
- Heart attack
- Perforation of the heart
- Bleeding at the entry part of the leg.
- A slight probability (1 -2%) of phrenic nerve damage.
Visiting an EP doctor some days before the procedure will help analyze your body condition. You will discuss the complications with the doctor to gauge the best treatment approach.
Atrial fibrillation is one of the most common heart-related complications. It is caused by numerous factors such as genes, age, heart complications, sick sinus syndrome, heart surgery, and lung diseases. Though numerous medications and procedures can be utilized, cryoablation is the safest and most effective procedure.
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Written By: Dr. Adolfo Carrillo
Dr. Adolfo Carrillo is a Board Certified Medical Doctor from Universidad Autónoma de Baja California.
Dr. Carrillo has been collaborating with Dr. Bautista for over 5 years as a treating physician at the Immunity the Immunity Therapy Center. Dr. Carrillo is a charismatic Doctor whose knowledge and commitment to patient care and bringing healing to patients is a valuable asset to our center.
At Immunity Therapy Center, our goal is to provide objective, updated, and research-based information on all health-related topics. This article is based on scientific research and/or other scientific articles. All information has been fact-checked and reviewed by Dr. Carlos Bautista, a Board Certified Medical Doctor at Immunity Therapy Center. All information published on the site must undergo an extensive review process to ensure accuracy. This article contains trusted sources with all references hyperlinked for the reader's visibility.