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Rosalee Johns says she has her life back thanks to a freezing therapy called cryoablation that restored her heartbeat to normal.
In 2008, Johns, then age 67, was diagnosed with atrial fibrillation, a condition in which the atria — the upper chambers of the heart — receive irregular electrical impulses that cause erratic heartbeats. Johns’ heart beat rapidly. She was light-headed and short of breath. The episodes occurred every three or four weeks, lasting 12 to 15 hours. Despite treatment with medication, the episodes increased to almost daily.
“I have always been a high-energy person, but atrial fibrillation drains your energy,” says Johns, who lives in Ponce Inlet, Fla. A retired auditor for the state of Indiana, she no longer could walk on the beach with visiting children and grandchildren. “Sometimes,” she says, “it was an effort to breathe.”
Increasingly debilitated, Johns asked her local cardiologist about other treatments. He pointed her to Mayo Clinic.
Fred Kusumoto, M.D., a cardiologist who specializes in electrophysiology at Mayo Clinic in Jacksonville, Fla., discussed her options, including cryoablation, a new therapy where tiny circles of heart tissue are frozen, blocking the abnormal electrical activity in the heart and restoring normal rhythms.
The therapy was tested at Mayo Clinic in Rochester, Minn., and in Jacksonville — and at 25 other medical centers around the United States. Cryoablation restored normal heartbeats for 70 percent of the 245 patients in the study, compared to 7.3 percent of patients successfully treated with medication.
Mayo Clinic was the first facility to offer the procedure, which the U.S. Food and Drug Administration approvedin 2010.
How cryoablation is done
Cryoablation is minimally invasive — no major incisions required. The surgical team threads a flexible plastic tube (catheter) through a vein, starting through a small incision near the groin and advancing to the heart. A tiny balloon is attached to the end of the catheter. Once the balloon is in place, physicians administer very cold liquid into the balloon. The coolant transforms into gas, expands and creates circles of lesions around the inside of the pulmonary vein in the heart. These lesions stop the errant electrical impulses causing the arrhythmia.
Dr. Kusumoto says that the procedure is similar to another treatment for atrial fibrillation where heat is used to create barriers to the electrical impulses. “The new technique reduces procedure time compared to heat ablation, says Dr. Kusumoto, who performed the cryoablation for Johns on June 2, 2011. “We are hoping that in the long run, cryoablation will restore a normal heartbeat with fewer risks and complications.”
Johns couldn’t be more pleased. “I have my life back. My energy has returned. My husband and I walked about 5 miles last week. Before, I could have walked maybe a block.”
The article comes from our Sharing Mayo Clinic print publication.
You claim that this procedure produces a circle of lesions around the inside of the pulmonary vein. How is this accomplished through cannulation of the femoral VEIN? A catheter threaded into the femoral vein passes into the vena cava and then into the right atria, right ventricle and pulmonary artery. The pulmonary artery takes unoxygenated blood to the lungs and that blood returns to the left side of the heart via the pulmonary veins. Unless this procedure makes a hole in the septum between the two atria, I don’t see how you can enter the lumen of the pulmonary veins via a peripheral venous approach. Are you sure the catheter is not threaded through the femoral ARTERY. This would provide a direct route back to the pulmonary veins via the aorta, left ventricle and left atria.
You have a wonderful understanding of anatomy- the catheter does go into the femoral vein but we make a small “opening or connection” between the right atrium and the left atrium using a very thin needle. Through this small opening we thread the balloon catheter to do the ablation. After a month or two the connection between the right atrium and left atrium closes spontaneously.
Again, thank you for your very thoughtful questions on the details of how we do this procedure. Sincerely, Fred Kusumoto.
Fred Kusumoto, this is unique; a doctor who takes time to respond in kindness and clarity. Thanks.
Just wondering. How many cases of cryoablation has mayo clinic done?
When did Mayo start doing cryoablation? How many cases has Dr. Venkat done? I am scheduled
to have this done on Sept. 24 by Dr. Venkat but am afraid of the procedure. Can you tell me about the success Mayo has had with this procedure. Will appreciate a response to this e mail.
We have had the technology for 1 year and have done a total of 94 cases so far. I have done 32 cases myself. Dr. Venkatachalam
I HAVE AFIB FOR OVER THREE YEARS,FIRST YEAR MAY BE 3 OR 4 TIMES, SECOND YEAR FEW MORE ONLY IN THE LAST YEAR THAT I KNOW AFIB IS. JULY 2012 HAD A PACE MAKER PUT IN SINCE THEN EVERY 10 .12DAYS I HAVE AFIB, I AM TAKING PILLS AND THEY SEEN TO HELP,BUT I STILL HAVE THEM,
I HAVE A HOME IN MARYLAND, AUG 24 I CAME TO OHAU HAWAII TO LIVE WITH MY DAUGHTER FOR 1 TO 3 YEARS I FEEL LIKE I NEED TO TAKE CARE OF THIS, HARD TO BREATH SOMETIMES, LAY AROUND IN BED. WOULD LIKE TO KNOW LOCATIONS CLOSE TO ME I FEEL MY LIFE FALLING APART I WAS WALKING 2 TO 3 MILES A DAY, NOT SO MUCH NOW,
PLEASE HELP ME MY HEALTH IS NOT BAD I AM A YOUNG 71 WEIGHT 240 HAVE LOST 50 POUNDS IN 14 MONTHS AND EXCEPT FOR THIS I FEEL GREAT,
THANK YOU
Kenny, we have received your post. Unfortunately we do not have Mayo Clinic campuses in Hawaii; we are located in Rochester, Minnesota; Jacksonville, Florida; and Scottsdale, Arizona. If you would like to seek help from Mayo Clinic, please call one of our appointment offices. The numbers can be found at http://www.mayoclinic.org/ under “request an appointment.”
How do you determine when conventional ablation is the best treatement vs cryoablation? My mother is scheduled for a procedure with Dr. Venkat in November.
Unfortunately, we cannot make specific treatment recommendations through this correspondence. If you would like to seek help from Mayo Clinic, please call one of our appointment offices. The numbers can be found at http://www.mayoclinic.org/ under “request an appointment.”
I have been having skipped heart beats for about a month,
different from PVCs I had in the past. Sometimes it is every
other beat. The doctor has put me on 25 mg. Metorprolol h.s.
I still have the skipped beats, but probably not as many.
How serious is this?
Gwen, we cannot diagnose conditions, provide second opinions or make specific treatment recommendations through this correspondence. If you would like to seek help from Mayo Clinic, please call one of our appointment offices. The numbers can be found at http://www.mayoclinic.org/ under “request an appointment.”
My wife is experiencing Afib and I am seeking a remedy for her situation
Unfortunately, we cannot diagnose conditions, provide second opinions or make specific treatment recommendations through this correspondence. You may be able to find additional information on the subject on our website at http://www.mayoclinic.com. If you would like to seek help from Mayo Clinic, please call one of our appointment offices. The numbers can be found at http://www.mayoclinic.org/ under “request an appointment.”
I have a/fib. Just how long from discovery to treatment?
we cannot diagnose conditions, provide second opinions or make specific treatment recommendations through this correspondence.
I am a 54 years old healthy, 6ft tall 185 lbs male. I was taking 80mgs of Inderal for migraines for little over a year. I slowly weaned off the medication but after a week or so I ended up in emergency a few times diagnosed with A-Fib. It would persist just about every three day for about two months. Some were so bad I couldn’t even get out of bed. Over the last three month it has gotten much better and now I only get moments of heart flutters. My questions: could the Inderal have cause this? – will it come back?
Hi Gary,
Thanks for the note, we’ll forward your question on for a possible reply.
Joel
Gary,
One of our physicians offers this response:
Inderal won’t cause it but it’s a common arrhythmia and can come back
Best of luck. Joel
Gary, here is a little more information on the subject from our physician. It’s a complex topic and you should seek futher guidance from your personal doctor.
Inderal is in a class of drugs called beta blockers, which by themselves will not cause atrial fibrillation. In fact, Inderal is one of the drugs that can be used to help the symptoms of atrial fibrillation. Atrial fibrillation itself is a very common arrhythmia and gets increasingly more common as one grows older. The likelihood of a recurrence at some point is quite high, and there is no good way to predict exactly when this will happen. In general, atrial fibrillation is not a life-threatening arrhythmia. Nevertheless, important issues, including plans for future management of recurrences if and when they occur, issues related to possibly needing medications to slow the heart rate, prevent atrial fibrillation, or thinning the blood should be discussed with a physician. In some cases where there are frequent symptomatic episodes a procedure called an ablation may be required.
Thanks you!
I started having af in September. In and out of hospital had cardio conversion on lots medicine.scheduled fora ablation in march .does everyone have the systomsofaf I have people think I am crazy I no but I cannot sleep out of breath lightheaded almost everyday. I had a seizure a few weeks ago from hear rate getting to low I can hardly do anything I have never been like this
Dr. Venkat, I have been dealing w/A-Fib since 2004. Beginning in 2005 until this past Oct., I was on the drug “Flecainide” with occasional break throughs. At one point I was on Coumadin for a year and then taken off as I had not had an episode for a year. Mine is a long, long story and heart history which came to a decision of doing a left ventricle ablation in early Dec. The procedure was begun and stopped after two hrs. due to excess fluid surrounding my heart. I am on Tikosyn, Losartan, Coreg and Warfarin presently and still having break throughs. I wish to come to Mayo Clinic for a 2nd opinion. I have a chart number as I have had “facet joint” injections there in 2007, 2009 and 2011. What procedure would I have to go through to see you or an associate electrophysiologist?
Thank you for your response,
Ann
I realize the subject for this correspondance was/is cyroablation but there was no mention of electo shock to eleminate or correct the Afib? as one would think would be an alternative.
Thanks for any response.
I am 68 years having Atrial Fibrillation and congestive Heart failure FOR OVER 6YEARS, I was using Coumadin and data blocker for over 2-3 years and finally I refused to take it anymore. I was scheduled for ablation procedure but also I refused, living from time to time on aspirin.
My pulse is so high and also my blood pressure in changing mood: 120-140-150-175 and pulse sometimes 80-120-140, but I am exercising from time to time making e.g. up to 30 push ups in workout. Doctor are amazed that I am not getting stroke and telling me all the time about it, but It is possible to happened, but still I am counting on Lord Jesus Christ. It will be so good if there will be any procedure without any risk to stop this condition. Is this procedure so called cryoablation restores my heartbeat to normal?
If you would, please contact me.
I have had paroxysmal lone a-fib since the fall of 2007. I have had 2 catheter ablations (2008 & 2009)and it was under control with medications also. My a-fib has gotten worse in the last couple of months. Am currently on 120 mg of cardizem. I am also perimenopausal and sometimes experience a hot flush after a bout with the a-fib. I know there is a connection sometimes with a-fib and the thyroid. Do you think there is also a connection with menopause? My doctors don’t really know. I also cannot take horomones, as I had breast cancer 8 yrs ago. Any help or advice would be appreciated. Thank you.
Is there a significant correlation between an incident of AF and a hyper thyroid?
Thanks
David
Please note the corrected email address regarding the question relat ed to Af and hyper thyroidism.
Thanks again.
David
I have had a fib for many years but very infrequently. In the past year it has gotten worse (I am 65 and in good health and taking Toprol 25 mg for my palpitations). Over the last three weeks my afib has been almost every night and I lose sleep. I take 300 mg of propafonone (spelling is incorrect-sorry)one to break the afib when needed. I am considering going on the med long term (relunctanly) and was wondering what the success rate of the cryoblation is and how long a procedure it is and is one under general anesthesia? I appreciate your attention to this matter.
Hi Stacey, Unfortunately we are unable to provide medical advice via this form of communication. Please contact us to set up an appointment at http://www.mayoclinic.org/patientinfo/appointments.html. Thank you.
My father, aged 77, has recently been diagnosed (1 year) with AFIB and we are wanting to come to the Mayo Clinic for treatment. His current dr. and electrophysiologist have him on Beta Blockers and blood thinners for several years. He is also on Synthroid for his thyroid problems. These seem to lower his heart rate, but he still has symptoms like low energy and increased breathing issues. Two months ago, they performed a cardioversion, which did not succeed. I have two questions 1) which Mayo Clinic should we go to? I could not determine if Arizona does the ablation or not 2) Since we’ve already seen a cardiologist and electrophysiologist in another state, can we request an electrophysiologist at the Mayo or do we have to see a cardiologist first? I guess I feel like we are starting over with another cardiologist vice going direct to a electrophysiologist. I appreciate your recommendation as soon as possible so we can schedule with the correct Dr. and location as quickly as possible. Thank you!
Hello and thank you for contacting us. We recommend that your father contact the Appointment Office directly and the representatives will be able to assist him in coordinating the consultations needed. (Arizona, 800-446-2279; Florida, 904-953-0853; Minnesota, 507-538-3270). Thanks again!
What are the success rates with the cryoablation therapy? My husband is 37 y/o with chronic a-fib with LV failure. Has had 5 total cardioversions and a RF ablation in 5/12, 3 cardioversions post the ablation. Has been on Amiodarone therapy for 3 yrs which has resulted in thyroid disease. His brother, age 39, suffers from the same condition, is there a genetic link with atrial fib? Considering 2nd opinion of Mayo Clinic Rochester.
HI Theresa, please contact our appointment office to schedule a second opinion. The phone number is 507-538-3270. Here is more information on a-fib. http://www.mayoclinic.org/atrial-fibrillation/
I have had A-fib for 2 1/2 yrs. I am 75. I had a cardioversion and it seemed to last for 2 yrs, but this week it came back. I am on propaphanone (sp?), and Metropol, a minimal amount. Will cardioverson help again? I am seeing my Drs. tomorrow, I just wondered if I can have a cardioversion over and over? The recommendation is to go on coumadin. I have been reading the other patient’s letters and wonder why people have such an aversion to coumadin. Anybody out there on it that is getting along well? Thanks
I was on Coumadin afew years ago for a pulmonary embolism. I had no problems with it then and ate regular meals even greens. Was only on it for 6 months till the clot dissolved. I have been on Coumadin again since Feb. 2013, on a regular diet and no problems so far. Also no excessive bleeding.
Forgot to say I am now on Coumadin for A-fib.
I have been on Coumadin for seven years because I have Afib. I eat regular meals with greens, salads, even have an occasional glass of wine. I am aware of what I am eating so I am very stable with INR being checked every five weeks. Some antibiotics can affect your numbers. Need to be sure doctors know of any over the counter nutrients/supplements you may be taking. High risk of stroke and pacemaker means Coumadin the rest of my life. I am 73 years old.
What has been the incidence of re-occurence of A-fib after the cryoablation vs. heat ablation?
I have A-Fib without any symptoms. It was diagnosed during a routine physical and my heart does not appear to otherwise have abnormalities. I am being urged to have an electroversion. I understand that there is the risk of A-Fib recurring and have three questions: First, what is the experience that you have had with such recurrance happening but now with symptoms that are troublesome? Second, is there normally a progression in treatments and if so, where do electroversion and cryoablation fit in that progression? Third, if electroversion is a simple initial procedure and one is considering ultimately coming to Mayo, should one have an electoversion done locally and see what the results are before making a switch of clinics?
Thank you for your note. I have forwarded your questions to Dr. Kusumoto and will post his reply when I hear back from him.
Hi David – I did receive a response from Dr. Kusumoto and it is posted below: Dear Mr. Minge,
These are great questions. When taking care of patients with atrial fibrillation (AF) I discuss stroke risk and management of symptoms. Of these addressing stroke risk is most important and you should discuss this with your physician.
Treatments such as electrical cardioversion or ablation are used to address symptoms. In your case AF was not associated with symptoms. However, the symptoms from AF can be difficult to identify since they are often gradual. In your case I would consider a cardioversion and assess whether or not you were having symptoms that you might have attributed to “getting older.”
If you in fact do feel better we will have learned that you actually did have symptoms associated with AF and procedures such as ablation (including using a cryo balloon technique) may be appropriate.
In many cases AF can be progressive and it is important for you and your physician to address conditions that may contribute to the development of AF such as hypertension and sleep apnea. In general the longer you are in AF the more difficult it is to treat and conversely the more you are in normal rhythm the more likely you will stay in normal rhythm.
I hope this helps.
Warmest regards,
Fred Kusumoto