Procedure used to permanently disable heart
arrhythmias
by using extremely cold temperature to destroy very small, carefully selected parts of the heart.
Parts of the Body Involved
Heart
Leg or arm
Reasons for Procedure
Cryoablation is performed to restore normal heart rhythm and permanently disable heart arrhythmias.
Risk Factors for Complications During the Procedure
A special ablation catheter is inserted and fed through a blood vessel up into the heart. Your doctor will watch its progress on a fluoroscope, an x-ray machine that provides continuous, real-time images of the inside of the body.
Once the catheter reaches your heart, your doctor will use another catheter tipped with an electrode in order to reproduce your arrhythmia. When the approximate location of this arrhythmia has been identified, your doctor will first test the area by cooling the ablation catheter tip to 30°C. This temperature will temporarily stop the arrhythmia if it has been correctly targeted, while being warm enough to avoid doing permanent damage to any nearby normal tissue, which will thaw and recover.
Once the exact location of your arrhythmia has been confirmed, your doctor will then cool the tip of the ablation catheter by another 100°C—down to -70°C. This extreme cold will freeze and scar the heart tissue, thus eliminating the arrhythmia. Your doctor will then try to reproduce the arrhythmia again and continue treatment until the arrhythmia can no longer be reproduced.
After the Procedure
You will be moved to a recovery room and observed for a few hours for symptoms, rhythm problems, and bleeding from the catheterization sites.
You may feel groggy from the sedative.
The catheter insertion site may be bruised and sore.
If the groin area was used as the insertion site, you will be instructed to lie in bed with your legs out straight.
If the wrist or arm was used as the insertion site, you will not need to stay in bed.
The sheath that was placed at the insertion point will be removed.
The insertion site will be monitored for signs of bleeding, swelling, or inflammation.
Your vital signs will continue to be monitored.
How Long Will It Take?
The procedure will take 2 to 4 hours.
Will It Hurt?
You may feel some minor discomfort as the catheter is inserted.
You may feel light-headed, experience a rapid heartbeat, or experience chest pain during the freezing process.
Possible Complications
Although complications are rare, they may include:
Damage to or perforation of the heart or blood vessels
Inadvertent interruption of normal conduction (requiring a pacemaker)
Most patients stay overnight for further observation and are discharged the next day.
Postoperative Care
When you return home after the procedure, do the following to help ensure a smooth recovery:
Take aspirin as prescribed, usually for 2 to 4 weeks, to minimize the risk of clot formation at the ablation sites.
Return to any usual light activities, such as walking or taking the stairs, but refrain from heavy lifting or any strenuous activity for 24 hours; in most cases, you will be able to return to your normal activity level within a few days.
Schedule a follow up visit with your doctor to check the catheterization sites and review the procedure.
Outcome
This procedure has an extremely high success rate and a low recurrence and complication rate. However:
Patients with atrial fibrillation or ventricular tachycardia may need to continue antiarrhythmic therapy.
Patients undergoing cryoablation of the AV node typically require a pacemaker.
Call Your Doctor If Any of the Following Occurs
It is essential for you to monitor your recovery once you leave the hospital. That way, you can alert your doctor to any problems immediately. If any of the following occur, call your doctor:
Signs of infection, including fever and chills
Extreme sweating or nausea
Your leg feels cold, turns white or blue, or becomes numb or tingly
Redness, swelling, increasing pain, excessive bleeding, or discharge at the point of catheter insertion
Difficulty breathing
Cough, shortness of breath, chest pain, or severe nausea or vomiting
RESOURCES:
American Heart Association http://www.americanheart.org
National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov
CANADIAN RESOURCES:
The Hospital for Sick Children http://www.sickkids.ca/
Women's Health Matters http://www.womenshealthmatters.ca/
References:
Catheter ablation of arrhythmias.
Circulation. 2002;106:e203.
Cryoablation for atrial fibrillation in association with other cardiac surgery. National Institute for Clinical Excellence website. Available at: http://www.nice.org.uk/page.aspx?o=238139. Accessed January 15, 2005.
Cryoablation heart surgery. The Nebraska Medical Center website. Available at: http://www.nebraskamed.com/heart/cryoablation.cfm. Accessed January 15, 2005.
Radiofrequency ablation. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4682. Accessed January 15, 2005.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
