A-Fib Patient Story #93
Prayer and CyroAblation: A-Fib Free! But Now Persistent PVCs
By AGL, December 2016
AGL first shared his story with A-Fib.com readers in August 2016 (My A-Fib Story: The Healing Power of Prayer, #88). Here, he shares the rest of the story…up-to-date and expanded.
In early 2011, I had my first heart episode. I sat down at my desk at work and my heart rate did not slow down. I was sitting there but my heart felt like I was jogging. I thought I’d sleep it off, so I went home and took a nap.
My First A-Fib Episode
It didn’t go away.
I eventually went to the ER where they said my heart rate was 235. They used adenosine which broke the episode, and my heart rate fell to 130s–140s.
They thought I had SVT [Supraventricular tachycardia] since my heart rate was so fast.
At this point they thought I had SVT [Supraventricular tachycardia], since my heart rate was so fast. If it was A-Fib ―it was difficult to determine due to the skewed heart rate graph. Since that was my first episode, I didn’t make any changes [to prevent future episodes]. I couldn’t be sure if it was simply a fluke or not.
Not a One-Time Fluke
But after a few more episodes within a year or two, I knew this wasn’t a one-time fluke.
I went to see a cardiologist who gave me three choices of proceeding: 1) do nothing 2) take medicine or 3) have an ablation. He didn’t recommend I go with an ablation due to risks involved.
I began taking 120mg of Cardizem, but that did not help―it simply slowed my heart rate and lowered by blood pressure. I was also taking 81mg of aspirin daily [for risk of stoke].
A-Fib Confounded by Sleep Disturbance
I wasn’t making progress in my A-Fib battle―and I was sleeping terribly. For three months I woke up every night at 2:30 a.m. Then, the rest of the night’s “sleep” was sketchy. (The sleep disturbance wasn’t caused by my A-Fib.)
After I came across an article online NSAIDs―The Unintended Consequences,
I told my cardiologist I was finished with taking Cardizem and asked how I could safely stop it.
Another decision is made, I told my cardiologist I was finished with taking Cardizem (120mg). I asked how I could safely stop it—did I need to wean off it or just stop cold turkey? He said, with a 120mg dose, cold turkey was fine. After I stopped taking the medicine, I was sleeping well.
A-Fib Episodes Every 4–6 Months
The A-Fib still hadn’t left. I had an episode every four to six months. My heart rate would go up to about 180 bpm and my heart felt like it was a fish trying to push through my chest.
I’d call 911 aach time and they’d come and either hook me up with Cardizem in my kitchen or in the ambulance to slow my heart rate. Then, while at the ER, my A-Fib would convert on its own.
The medicine they gave me never helped my heart rhythm―only heart rate. My heart rhythm would convert from A-Fib to sinus on its own.
My Pastors Pray for My Healing
As I shared before, being a Christian and believing what God says in the Bible about what He can do―I asked my pastors to anoint me with oil and pray over me for healing―as laid out in the book of James. They did that, and I did not have another A-Fib episode for 15 months.
I asked my pastors to anoint me with oil and pray over me for healing―as laid out in the book of James.
God touched me and stayed the A-Fib for that amount of time.
God’s Timing: Considers CryoAblation
After 15 months I had another A-Fib episode. This was around the beginning of 2013. At that point my cardiologist recommended I consider the CryoAblation.
Now that I look back on the timing of things, I think God chose to get me through the 15 months so more advancements could be made on the CryoAblation procedure for it to be safe for me to have it performed. He has His own reasons for sometimes miraculously and permanently healing some―and not permanently healing others.
I read about the CryoAblation procedure―mostly on StopA-Fib.org. The statistics proved good success rates and low risk―besides the obvious of it being invasive―and involving the heart.
Choosing an EP: High-Volume=Lower Complications
I had read that cardiologists/EPs who perform Cryoablations regularly [20 to 50 ablations/year] had increased safety statistically than compared to the ones who performed only a few. Well, it turned out my EP had performed 50 of them before mine. So, that made me feel a lot more comfortable! [See our article: Catheter Ablation: Complications Highest With Low-Volume Doctors]
So, in mid 2013 I had a CryoAblation for my A-Fib. And, I’m happy to say that the ablation was successful. I have not had an episode of A-Fib since!
I’m A-Fib Free! But Now Persistent PVCs
Life has been uneventful heart-wise until recently.
I have had persistent PVCs for a few months now. I basically have them 24/7…sometimes minutes apart sometimes seconds apart―but I don’t have any side effects except an occasional slight flush feeling in the face, but that’s it.
Testing for Magnesium Deficiency
After some research online, it seems like magnesium deficiency would be something to investigate first. But the common blood serum test [Red Blood Cell Count (RBC)] to determine magnesium levels is unreliable (your body works to keep your blood serum levels consistent or your heart would stop).
What you want tested is your intracellular level of magnesium―which the Exatest [Energy Dispersive X-Ray Analysis] measures. That test is performed by a lab in California named Intracellular Diagnostics. I had that test done, and my intracellular Mg level was 34 while the lowest number within “normal” is 32. [See: Serum vs Intracellular Magnesium Levels]
But, according to an article on livingwithatrialfibrillation.com, Travis’ doctor says that “normal” can be different per person. So, although I’m within the defined “normal” range…maybe my personal normal is 36 or 38 or something.
Electrolytes in Normal Range—But Not Magnesium
For what it’s worth, the majority of my other electrolytes within the test were spot on in the middle of the “normal” range―while Mg was not. So, I’m taking that as meaning I may be Mg deficient.
So, I have been taking Natural Rhythm’s Triple Calm Magnesium with three types of chelated magnesium. I’ve read it takes a while to raise your intracellular levels of Mg, so it will take time to see if this works or not.
Also, for what it’s worth―my PVCs seem to be affected by the vagus nerve. Sometimes sitting down seems to magnify the PVCs. They also seem more pronounced after heavier meals sometimes. This is an interesting 2011 article about the vagus nerve and PVCs.
Asks God for Guidance
I’ll continue to try what I can, and ask God for guidance all the while. After all, He made the heart! Too bad that in this fallen world it’s susceptible to malfunctioning at times―partly due to it simply being a fallen world and partly because we don’t follow His ways that are designed to keep us from disease.
I’ll hold onto His promise that says:
“And we know that all things work together for good to those who love God, to those who are called according to His purpose.” (Romans 8:28, NKJV)
Magnesium Deficiency: Congratulations to AGL for investigating his magnesium level and going beyond the common blood serum test to measure his intracellular level of magnesium.
If you have A-Fib, it’s safe to assume you are magnesium deficient. Most everyone is. Magnesium has been depleted from the soil by industrial scale farming. It’s hard to get enough magnesium from today’s food.
Consider taking magnesium supplements. It takes about 6 months of taking magnesium supplements to build up healthy Mg levels. For more about A-Fib and Magnesium Deficiency, see our articles:
• Cardiovascular Benefits of Magnesium: Insights for Atrial Fibrillation Patients
• Mineral Deficiencies/Magnesium
• Low Serum Magnesium Linked with Atrial Fibrillation
PVCs and PACs (Extra Beats): PVCs (Premature Ventricular Contractions) and PACs (Premature Atrial Contractions) are often considered benign. Everybody gets them occasionally, not just people with A-Fib. But A-Fibbers seem to have more problems with extra beats than healthy people. After a successful A-Fib ablation, patients seem to have more extra beats. But, unlike in AGL’s case, they usually diminish over time as the heart heals and gets used to beating properly.
But the sources of PACs/PVCs signals can also be mapped and ablated just like A-Fib sginals. Also, beta blockers and antiarrhythmic drugs may help diminish those extra beats.
Catheter Ablation can make you A-Fib free: The options AGL’s cardiologist gave him in 2011 really weren’t equal.
• “Doing nothing”. This was impractical for AGL considering how badly A-Fib affected him, how often he had to call the paramedics and go to the ER.
• “Take Medications.” AGL tried Cardizem (a Calcium Channel blocker rate control drug), but it didn’t work for him. He might have tried various antiarrhythmic drugs, but their record isn’t good.
• “Ablation, but not recommended.” Though there is risk with any procedure, even AGL’s cardiologist eventually recommended he get an ablation in 2013.
An ablation is a low risk procedure with a high rate of success. Currently it’s the only option that offers hope of fixing one’s A-Fib and becoming A-Fib free.
A-Fib begets A-Fib: Atrial Fibrillation is a progressive disease. The longer you have it, the greater the risk of your A-Fib episodes becoming more frequent and longer. Over time this can lead to fibrosis making the heart stiff, less flexible and weak, reduce pumping efficiency and lead to other heart problems.
Don’t let your doctor leave you in A-Fib. Educate yourself. And always aim for a Cure! To learn more, read my editorial, Leaving the Patient in A-Fib—No! No! No!
Technology & 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.)
Return to Index of Articles: Research and Innovations
Last updated: Wednesday, August 26, 2015
Technology & Innovations
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
Return to Index of Articles: Research and Innovations
Last updated: Sunday, February 15, 2015
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 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.
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
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.
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.
Last updated: Sunday, February 15, 2015
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.
- US EPs with FHRS-designation performing A-Fib ablations: Listed by State/City
- US EPs Using Cryoballoon Ablation
- US EPs Installing the Watchman Device
- US Surgeons performing Maze and Mini-Maze operations
- US Centers performing the Hybrid Surgery/Ablation procedure
- EPs Specializing in Persistent/Long-Standing Persistent A-Fib (US and International)
- EPs using Contact Force sensing catheters
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 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
Alaska Heart Institute
Cavanaugh Heart Center
St. Jude Medical Center
UC Irvine Healthcare
Cedars-Sinai Medical Center
Good Samaritan Hospsital
Kaiser Foundation Hospital Sunset
Regional Cardiology Associates, Sacramento/Sutter Memorial Hospital
University of Colorado Hospital
Colorado Heart & Vascular/St. Anthony Central Hospital
University of Florida, Gainesville/Cardiovascular Outpatient Clinic
Health First Medical Group
Orlando Heart Center
Heart Specialists of Sarasota
St. Joseph’s Hospital
University of South Florida/Morsani School of Medicine
Piedmont Heart Institute
Emory University Hospital, Cardiac EP Lab
Cardiovascular Consultants, PC/Memorial Health University Medical
Midwest Heart Specialists, Elmhurst Memorial
Memorial Advanced Cardiovascular Institute
Iowa Heart Center, Ames
Iowa Heart Center
Tulane School of Medicine/Tulane Medical Center Hospital
Brigham and Women’s Hospital
Massachusetts General Hospital
The Cardiovascular Specialists
HealtEast Saint Joseph’s Hospital
Central Minnesota Heart Center/St. Cloud Hospital
St. Paul Heart Clinic
University of Mississippi Medical Center
Cardiovascular Consultants, Cape Girardeau
Bryan LGH Heart Institute
Heart Consultants PC
Bergan Cardiology Specialists/Bergan Mercy Medical Center-Alegent
Morristown Memorial Hospital/Electrophysiology Associates
Staten Island University Hospital, EP
Asheville Cardiology Associates
Memorial Mission Hospital
The Ohio Heart & Vascular Center
Mount Carmel Columbus Cardiology Consultants
The Ohio State University, Division of Cardiovascular Medicine
Oklahoma Heart Hospital
Oklahoma Heart Institute/Hillcrest Medical Center
Columbia Heart Clinic/Palmetto Richland Memorial Hospital
Sanford Cardiovascular Institute
Cookeville Regional Medical Center
Stern Cardiovascular Center, PA/Baptist Memorial Hospital
Memphis Heart Clinic
Centennial Heart Cardiovascular Consultants
St. Thomas Heart at Baptist Hospital
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
Leachman Cardiology/Texas Heart Institute/St. Luke’s Episcopal Hospital
Arrhythmia Associates/Inova Research Center
Richmond Cardiology Associates
Virginia Commonwealth Un. Medical College-Medical College of Virginia
Swedish Heart and Vascular Clinic
Virginia Mason Heart Institute
Wheaton Franciscan Medical Group/St. Francis Hospital
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.
Last updated: Saturday, May 14, 2016