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CryoAblation

North American Arctic Front Stop-AF Trial

FAQs A-Fib afibTechnology & Innovations

North American Arctic Front Stop-AF Trial

Results from the North American Arctic Front STOP-AF trial did show a PV stenosis rate of 3.1% which did not show up in the European trials. This may have come from the use of a smaller 23 mm balloon which possibly penetrates too far into the Pulmonary Vein opening.)

VIDEO: To see a video demonstration of the CryoBalloon Catheter, go to http://www.cryocath.de/en/4.products/af.presentation.asp

Preliminary anecdotal comments from doctors indicate that Cryo ablations may have more reconnection/reconduction problems than RF (perhaps because Cryo doesn’t damage heart tissue as much as RF). And the two sizes of Cryo balloons don’t always fit neatly into pulmonary vein openings.

The Cryo (freezing) can affect the Phrenic Nerve and cause breathing problems, but these usually resolve over time.

The North American Arctic Front STOP-AF trial showed a Phrenic Nerve Palsy (paralysis, weakening) of 11.2 %. Some of these cases did not resolve within 12 months (18 %). This Phrenic Nerve damage may have come from the use of the smaller 23 mm balloon which gets closer to the Phrenic Nerve. Dr. Kuck has had good results using only the larger 28 mm balloon.Doctors doing CryoBalloon ablations now pace the Phrenic Nerve during the ablation. If they notice that the Phrenic Nerve is affected by the Cryo (freezing), they immediately stop the ablation. The Phrenic Nerve “defrosts” and returns to normal. This technique reportedly eliminates cases of Phrenic Nerve Palsy.

In some centers the CryoBalloon catheter has to be withdrawn and RF non-balloon catheters inserted to “touch up” areas the balloon catheter missed, which often requires considerable time and more fluoroscopy exposure. This also increases the cost of an A-Fib ablation, so that hospitals and insurance companies may actively discourage the use of additional catheters.

However, with more experience doctors may overcome these problems.

(The CryoBalloon catheter may be a “Gateway Technology” allowing many more doctors to enter the field. The number of A-Fib doctors today can take care of less than 1% of the A-Fib population annually. An increase in the number of doctors able to perform successful A-Fib ablations would be a major help in our current A-Fib epidemic. But in these first days of CryoBalloon ablation, patients should be cautious and seek out high volume, experienced centers.)

(Posted 3/7/11)

References for this article

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Return to Index of Articles: Research and Innovations

Last updated: Wednesday, August 26, 2015

Balloon Catheters/Cryoballoon Catheters

Technology & Innovations 

Arctic Cryoballoon Catheter

Arctic Cryoballoon Catheter

Balloon Catheters/Cryoballoon Catheters

One of the most exciting, important new technologies for A-Fib patients is the recently FDA approved CryoBalloon Catheter. The balloon system can be used to fit into a Pulmonary Vein opening, then ablate it with a minimum number of lesions.

Arctic Cryoballoon Catheter

This could be a vast improvement over current RF catheters which use pinpoint lesions to perform large-area ablations in a point-by-point fashion and which require a great deal of operator skill and manual dexterity. CryoBalloon ablations might become easier and faster to do than RF.

Using the energy source Cryo to make ablations may also be a major improvement for A-Fib patients. Cryo uses very cold temperatures to freeze tissue to create lesions without the vaporization, charring, and tissue damage of RF. It preserves heart tissue integrity rather than burning it. When cold temperatures are applied, Cryo catheters stick to the heart tissue they touch, much like a tongue on cold metal. Since the heart is beating and in constant motion during an ablation, this is a significant advantage. And Cryo produces no crust formations. RF burns can cause a crust to form over the ablated area (called a “thrombus”). This crust can fall off and lodge in a blood vessel, perhaps causing a blood clot and stroke. (That’s one of the reasons blood thinners like heparin are used during RF ablations, to prevent these blood clots.)

CryoBalloon Safer for Patients

In the clinical trials, the CryoBalloon catheter was safer for patients. There were no strokes, no pulmonary vein stenosis, no esophageal injury, and no coronary artery injury as sometimes occurs with RF ablation. There is also little danger of perforation and tamponade with the CryoBalloon catheter.

For a more detailed look at these new technologies, see Drs. Burkhardt and Natale’s article from which most of this report is taken: Burkhardt, JD, Natale, A. “New Technologies in Atrial Fibrillation Ablation,” Circulation. 2009;120:1533-1541. Last accessed Jan 11, 2013. http://circ.ahajournals.org/cgi/content/full/120/15/1533?eaf

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Return to Index of Articles: Research and Innovations

Last updated: Sunday, February 15, 2015

A CryoAblation Primer

Arctic Cryoballoon Catheter

Arctic Cryoballoon Catheter

By Steve S. Ryan, PhD

The first CryoAblation balloon catheter was approved for A-Fib use in December 2010 (the Medtronic Arctic Front system). According to a pioneer in the technique, Dr. Walter Kerwin of Cedars-Sinai-Los Angeles, CryoAblation seems to have definite advantages over RF. (Dr. Kerwin performed the first catheter Cryo ablation in the Western United States in 2005.)

CryoAblation In-Depth

CryoAblation allows a doctor to test an ablation before making it permanent. Heart tissue can be slightly frozen to test whether it is responsible for producing A-Fib signals. That tissue can then be re-warmed and restored to its normal electrical function. Heat-based therapies like RF don’t allow that—once the heart tissue is burned, it stays burned.

With CryoAblation there is less risk of damaging other areas of the heart or esophagus.

With CryoAblation there is less risk of damaging other areas of the heart or esophagus. Often in catheter ablation doctors have to work close to critical structures such as the heart’s pacemaking system, the esophagus, or the coronary arteries. For example, an RF ablation in the wrong spot can block the normal electrical conduction in the heart and require the surgical insertion of a permanent pacemaker. With CryoAblation (which freezes tissue instead of ablating it), the risk of damage to critical structures in minimized.

CryoAblation minimizes the risk of perforation. Because CryoAblation preserves heart tissue integrity rather than burning it, there is minimal risk of perforation. For example, a CryoAblation catheter is less likely to perforate the atrial wall.

With CryoAblation there is little or no discomfort or pain during the procedure. Like putting a cold pack on a pulled muscle, the freezing acts as a natural anesthetic.

With CryoAblation there is less risk of Stenosis (swelling). An RF ablation in the Pulmonary Vein openings can sometimes result in Stenosis (swelling or narrowing of the Pulmonary Vein opening) which restricts or blocks blood flow. Since CryoAblation does not burn and instead preserves heart tissue integrity, there is less risk of Stenosis.

When cold temperatures are applied, CryoAblation catheters stick to the heart tissue they touch, much like a tongue on cold metal. Since the heart is beating and in constant motion during an ablation, this is a significant advantage over RF. The ability of the CryoAblation catheter to stick to the exact spot to be ablated, helps the doctor avoid any accidental slips of the catheter tip, thereby preventing damage to nearby critical structures.

CryoAblation produces no crust formations. RF burns can cause a crust to form over the ablated area (called a “thrombus”). This crust can fall off and lodge in a blood vessel, perhaps causing a blood clot and stroke. (That’s one of the reasons blood thinners like heparin are used during RF ablations, to prevent these blood clots.) With CryoAblation, this risk of thrombus is minimized.

CryoAblation Research Study

Ablating using the CryoCath balloon catheter appears to be faster and easier, as well as safer than RF. A 2008 study described long-term data involving 346 patients with Paroxysmal (393) or Persistent (53) A-Fib.

Following one Cryoballoon ablation, 74% of Paroxysmal patients were free of A-Fib and in permanent sinus rhythm. But this figure was much lower for those with persistent A-Fib―just 38%. There were no strokes, no pulmonary vein stenosis, no esophageal injury, and no coronary artery injury as sometimes occurs with RF ablation (RF ablations typically have a major complication rate of around 4%).

The main complication reported was a temporary palsy of the phrenic nerve. According to Dr. Philippe Ritter, president of Cardiostim, “Cryoballoon (with the Cryoballoon catheter) appears to have a lower complication rate than RF ablation and is easier to perform…but we need some more years to look at it and compare it with RF ablation.”

Interpreting the Results

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A 74% cure rate for the CryoCath balloon catheter is similar cure rates for RF ablations for Paroxysmal A-Fib. The low 38% cure rate for Persistent A-Fib might be due to only having one ablation. Most RF ablation procedures for Persistent A-Fib now require two or more ablations. (See: 95% Success Rate in Curing Persistent A-Fib/Boston A-Fib Symposium 2007.) Also, in this study only the Pulmonary Vein openings were treated with the CryoCath balloon catheter. They did not attempt any other lines or lesions as is commonly done with RF ablations for Persistent A-Fib. Persistent A-Fib is more complex and difficult to cure. As doctors get more experienced with CryoAblation, they may well be able to achieve similar success rates as RF for Persistent A-Fib.

In the future we may see centers first use Cryoballoon catheters to isolate the Pulmonary Veins because it is safer, easier, and uses less fluoroscopic exposure; and secondly use RF or non-balloon Cryo catheters for linear lesions and to target other areas of the heart in more complex cases of Persistent A-Fib. CryoAblation is already being used to ablate near the esophagus to prevent Atrial-Esophageal Fistula.

Cryoballoon catheter ablation may also be the answer to the problem of re-do’s. All too often RF ablation patients have to return for a second ablation, because of re-growth and reconduction of the RF ablated areas, and because PV isolation with RF is difficult to achieve in a uniform fashion, even with experienced operators. Circumferential ablation with small-tipped catheters often results in gaps in the lesions lines and uneven scar formation. The Cryoballoon catheter ablation may solve this problem because of its ability to easily and quickly produce uniform pulmonary vein isolation.

The Cryoballoon catheter looks to be a major improvement in the treatment of A-Fib with close to 100% success rate in isolating the PVs, and 75-80% success in keeping patients free of A-Fib without anti-arrhythmic drugs.

Conclusion

Doctors have been doing RF ablations for years. It works. The Cryoballoon and RF catheter ablations are pretty much equally effective. The Cryoballoon is safer, but not that much safer than RF which is a low risk procedure.

If I had a choice between the Cryoballoon and RF, I’d probably choose the Cryoballoon. But a RF ablation remains a good option with a high success rate and low complication rate.

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Return to Index of Articles: Catheter Ablation

Last updated: Sunday, February 15, 2015 

References for this article

Steve’s Lists of A-Fib Doctors by Specialty

Steve's Lists of Doctors by Specialty - Atrial Fibrillation, afib, a fib, A-Fib

Doctors by Specialty

Steve’s Lists of A-Fib Doctors by Specialty 

Steve has prepared these lists of doctors treating atrial fibrillation patients by specialty to help you find doctors with a particular expertise.

  1. US EPs with FHRS-designation performing A-Fib ablations: Listed by State/City
  2. US EPs Using Cryoballoon Ablation
  3. US EPs Installing the Watchman Device
  4. US Surgeons performing Maze and Mini-Maze operations
  5. US Centers performing the Hybrid Surgery/Ablation procedure
  6. EPs Specializing in Persistent/Long-Standing Persistent A-Fib (US and International)
  7. EPs using Contact Force sensing catheters

Return to Directory of Doctors Treating A-Fib: Medical Centers and Practices

Notice: unlike other directories, A-Fib.com offers no preferential listings or placement. No doctor or facility pays, provides services, etc. to be listed. We accept no fee, benefit or value of any kind for listing a specific doctor or medical center. A-Fib.com is not affiliated with any practice, medical center or physician.

If you know the name of the doctor or practice, use the “Search our site” box (upper right on this page) to get to the right Directory page. Then, open your browser’s ‘Find on Page’ feature (‘CTRL+F’) to locate the name on the page.

Disclaimer: this directory is provided for informational purposes only. We make no endorsement of a specific physician or medical facility. Choosing a physician is an important decision and should be based upon your own investigation of each physician’s training, education and experience. These listings offer you the opportunity to locate and contact a healthcare professional directly. 

A-Fib.com is your independent source of unbiased information about Atrial Fibrillation, resources and treatments.

Last updated: Tuesday, September 6, 2016

US Doctors Using Cryoballoon Ablation – a List by A-Fib.com

Steves List logo 200 pix at 96 resUS Doctors and Centers Using CryoBalloon Ablation

The FDA approved the CryoBalloon Catheter in December 2010. It appears to be a major advancement in the treatment of A-Fib. We’ve compiled a list of Medical Centers and doctors using the CryoBalloon Catheter and organized it by US state (when applicable).

Alaska · Arizona ·  California · Colorado · Florida · Georgia · Illinois · Indiana · Iowa · Louisiana ·  Massachusetts · Michigan · Minnesota · Mississippi · Missouri · Nebraska · New Jersey · New York · North Carolina · Ohio · Oklahoma · Pennsylvania · South Carolina · South Dakota · Tennessee · Texas · Virginia · Washington ·  Wisconsin 

HOW TO FIND THE CONTACT INFO

Return to Steve’s Lists of A-Fib Doctors by Specialty


ALASKA

Alaska Heart Institute 

ARIZONA

PHOENIX

Cavanaugh Heart Center 

CALIFORNIA

FULLERTON/SOUTH ORANGE

St. Jude Medical Center

UC Irvine Healthcare 

LOS ANGELES

Cedars-Sinai Medical Center

Good Samaritan Hospsital

Kaiser Foundation Hospital Sunset

USC

SACRAMENTO

Regional Cardiology Associates, Sacramento/Sutter Memorial Hospital

COLORADO

AURORA

University of Colorado Hospital

DENVER

Colorado Heart & Vascular/St. Anthony Central Hospital

FLORIDA

GAINESVILLE

University of Florida, Gainesville/Cardiovascular Outpatient Clinic 

MELBOURNE

Health First Medical Group

ORLANDO

Orlando Heart Center

SARASOTA

Heart Specialists of Sarasota

TAMPA

St. Joseph’s Hospital

University of South Florida/Morsani School of Medicine

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GEORGIA

ATLANTA

Piedmont Heart Institute 

Emory University Hospital, Cardiac EP Lab 

SAVANNAH

Cardiovascular Consultants, PC/Memorial Health University Medical

ILLINOIS

ELMHURST 

Midwest Heart Specialists, Elmhurst Memorial

INDIANA

SOUTH BEND

Memorial Advanced Cardiovascular Institute 

IOWA

AMES

Iowa Heart Center, Ames    

DES MOINES 

Iowa Heart Center  

LOUISIANA

NEW ORLEANS

Tulane School of Medicine/Tulane Medical Center Hospital

MASSACHUSETTS

BOSTON

Brigham and Women’s Hospital

Massachusetts General Hospital 

BURLINGTON

Lahey Clinic  

HYANNIS

The Cardiovascular Specialists

MICHIGAN

DETROIT

Harper Hospital

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MINNESOTA

MAPLEWOOD

HealtEast Saint Joseph’s Hospital 

ST. CLOUD

Central Minnesota Heart Center/St. Cloud Hospital 

SAINT PAUL

St. Paul Heart Clinic

MISSISSIPPI

JACKSON

University of Mississippi Medical Center 

MISSOURI

CAPE GIRARDEAU

Cardiovascular Consultants, Cape Girardeau 

NEBRASKA

LINCOLN

Bryan LGH Heart Institute 

OMAHA  

Heart Consultants PC 

Bergan Cardiology Specialists/Bergan Mercy Medical Center-Alegent

NEW JERSEY

MORRISTOWN

Morristown Memorial Hospital/Electrophysiology Associates 

NEW YORK

STATEN ISLAND

Staten Island University Hospital, EP 

NORTH CAROLINA

ASHEVILLE  

Asheville Cardiology Associates

Memorial Mission Hospital

OHIO

CINCINNATI

The Ohio Heart & Vascular Center 

COLUMBUS

Mount Carmel Columbus Cardiology Consultants 

The Ohio State University,  Division of Cardiovascular Medicine

OKLAHOMA

OKLAHOMA CITY

Oklahoma Heart Hospital 

TULSA

Oklahoma Heart Institute/Hillcrest Medical Center

PENNSYLVANIA

HARRISBURG

York Hospital

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SOUTH CAROLINA

COLUMBIA

Columbia Heart Clinic/Palmetto Richland Memorial Hospital 

SOUTH DAKOTA

SIOUX FALLS

Sanford Cardiovascular Institute 

TENNESSEE

COOKEVILLE

Cookeville Regional Medical Center 

GERMANTOWN 

Stern Cardiovascular Center, PA/Baptist Memorial Hospital 

MEMPHIS

Memphis Heart Clinic 

NASHVILLE

Centennial Heart Cardiovascular Consultants    

St. Thomas Heart at Baptist Hospital

TEXAS

DALLAS

Univ. of Texas Southwestern Medical Center/Univ Hospital St. Paul 

Cardiology Consultants of Texas/Baylor Heart and Vascular

North Texas Heart Center

Medical City of Dallas

Medical City Dallas Hospital

HOUSTON:

Leachman Cardiology/Texas Heart Institute/St. Luke’s Episcopal Hospital

VIRGINIA

FAIRFAX

Arrhythmia Associates/Inova Research Center 

MECHANICSVILLE

Richmond Cardiology Associates 

RICHMOND

Virginia Commonwealth Un. Medical College-Medical College of Virginia

WASHINGTON

SEATTLE   

Swedish Heart and Vascular Clinic 

Virginia Mason Heart Institute 

WISCONSIN

MILWAUKEE

Wheaton Franciscan Medical Group/St. Francis Hospital


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NOTICE: we offer no preferential listings. We accept no fee, benefit or value of any kind for listing a specific doctor or medical center. A-Fib.com is not affiliated with any practice, medical center or physician.

HOW TO FIND CONTACT INFO: Use the “Search our site” box (upper right on this page) to get to the right Directory page. Then, open your browser’s ‘Find on Page’ feature (‘CTRL+F’) to locate the name on the page.

Disclaimer: this directory is provided for your convenience only.  We make no endorsement of a specific physician or medical facility. Choosing a physician is an important decision and should be based upon your own investigation of each physician’s training, education and experience. This directory offers you the opportunity to locate and contact a healthcare professional directly.

 A-Fib.com—your independent source of unbiased information about Atrial Fibrillation, research and treatment options.
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Last updated: Saturday, May 14, 2016

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