Cryoablation – with cold at the source of arrhythmias

In cryoablation, negative temperatures are used to precisely inactivate tissue fragments responsible for faulty conduction of electrical impulses in the heart. Cold ablation has the greatest application in the treatment of atrial fibrillation – a dangerous arrhythmia typical of old age, from which approx. 10 percent. people over the age of 75.

In the therapy of atrial fibrillation substrateoIn the efficiency of cryoablation reaches up to 80 percent. It is worth knowing that this method is safe and reimbursed – mowi dr n. biol., drug med. Adam Sokal of the Heart Rhythm Section of the Polish Society of Cardiology.

The primary indication for cryoablation is the treatment of atrial fibrillationoin the heart. This arrhythmia is a particularolnie dangerous because it increases the risk of ischemic stroke fivefold mozgu, causes circulatory failure and increases the risk of death.

Ablation is a therapy directed at the intentional destruction of fragments of theoin the tissues, responsible for impaired conduction and generation of impulsesoin electrical in the heart. Atrial fibrillationow is most often triggered by electrical excitations generated in the pulmonary veins. Source ablation procedureoThe cause of this arrhythmia is isolation of the pulmonary vein outlets to the left atrium of the heart using radiofrequency (RF) current or the application of low temperature (minus 35 to minus 60 degrees – cryoablation).

– During the cryoablation procedure, we use cold to try to destroy the tissue fragments responsible for the abnormal formation and propagation of impulseow of electrical activity in the heart. This allows to organize the heart. The desired effect of the procedure is to restore theoprice of coordinated atrialoin and ventricularor of the heart. It can be cfoto restore theocenia wspocooperation between the atria and ventricles – mowi Sokal.

The procedure of cryoablation of atrial fibrillationow, like radiofrequency (RF) ablation, cannot be performed in all patientsoin with atrial fibrillationow. A contraindication to this procedure is the presence of a thrombus in the left atrium of the heart. In addition, it is not performed in patientsow with recent ischemic stroke moThe procedure is always carried out individually in patients with a recent ischemic stroke, shortly after a myocardial infarction or in patientsow with failure of theownana heart failure. Once the thrombus has dissolved, or the patient’s condition has stabilized, ablation can be reconsidered. Of course, if the cause of atrial fibrillation atrialow is hyperthyroidism or a significant valvular defect, the underlying disease of fibrillation should be treated first.

Qualification for the procedure is always performed individually. Although there is no gohe patient’s age limitoIn those qualified for cryoablation, the chance of curing an arrhythmia decreases with age. Hence, in the case of waspsob after the age of 80 should be especiallyoln a careful assessment of the patient’s chances of curing the arrhythmia so as not to put the patient at unreasonable risk.

The goal: to inactivate the sourceothe bottom of arrhythmias

As mentioned earlier, for atrial fibrillationow the target of ablation are the pulmonary vein outlets to the left atrium, since experience shows that abnormal electrical signals initiating fibrillation are most often generated in them. In other cases, before the doctor performs RF ablation or cryoablation, which involves the deliberate destruction of a fragment of theoin the tissue responsible for the arrhythmia, seeks the source of the arrhythmiaoThe sources of abnormal signalsoIn electrical and abnormal drog of their propagation.

During the procedure, the doctor punctures a vein, usually in the groin, through which he inserts a special catheter into the heart and directs it to the tissues responsible for the formation of rhythm disturbances. In the case of cryoablation, a cooling agent is introduced into the catheter – nitrous oxide. It does not come out of the catheter, but only cools its tip, located in the heart, to minus several tens of degrees Celsius, damaging the area responsible for the formation of cardiac arrhythmias. After cold application, the active tissue in the area is destroyed and is „deactivated” – can no longer conduct impulseoin electrical, and thus cause arrhythmias.

Advantages of cold therapy

Cryoablation performed withoboth point and area (using a cooling balloon) – as is the case in atrial fibrillationow) is a procedure that is reversible up to a certain stage. We can perform proand check whether this area of tissue is responsible for the formation of arrhythmias. We cool such an area only for a while – if it turns out to be inappropriate or there are unexpected effects of our action, we stop the freezing process and the tissue is again able to conduct impulses. This possibility makes it easier for us to determine the exact location of the arrhythmia and increases the safety of the procedure.

This type of cryoablation, the so-called. point cryoablation, can be used to treat regular tachycardiaow, especiallyolnie if the foci responsible for their formation are located close to structures thatorych unintentional destruction can lead to serious consequences.

Balloon cryoablation allows in one „freezing” Destroy a significant area of abnormal tissue and isolate foci of arrhythmia. In the case of atrial fibrillationow are usually found in the pulmonary veins, the vessels that lead blood from the lungs to the left atrium of the heart. This method brings the best results in patientsoIn the early stages of the disease with a paroxysmal form of atrial fibrillationoin and the typical anatomical arrangement of the pulmonary veins. The remote efficacy of balloon cryoablation, understood as the percentage of patientsow with atrial fibrillationow, in whomohe arrhythmia does not occur within 6-12 months after the procedure, judging from approx. 60 to 80 percent.

You have to wait for the effect

Whether or not the ablation procedure has completely eliminated the cause of AFow, is known approximately three months after the procedure. The process „neutralization”, i.e. onotissue healing, is gradual – it lasts for several weeks. Only about three months after the procedure is performed are we able to assess the effectiveness of the cryoablation performed. If the effects of the procedure are not fully satisfactory, we can schedule a repeat procedure.

Important for the patient

No food should be consumed for 6 hours before the procedureow nor drink. However, if you are taking any permanent medications, you can take them with a little water. If you are taking antiarrhythmic drugs, your doctor may ask you not to take them for a certain amount of time before the ablation. Approximately 12 hours before the procedure, the area around both groins should be thoroughly shaved – shirts will be inserted in these areas, followed by electrodes.

Ablation is a safe procedure. Extremely rarely, serious complications such as tamponade (the appearance of a large amount of fluid in the wok may occuroheart) or atrioventricular block, requiring implantation of a pacemaker. Sometimes during cryoablation of atrial fibrillation theow Transient paralysis of the phrenic nerve may occur. It subsides from a few minutes to a few days after the procedure, very rarely persisting for more than a month. Quite often after the procedure there are harmless bole of the head, spontaneously passing within several hours. The most common complication is a hematoma at the injection site, whichory occurs in 2-3 percent of. patientow.

The cryoablation procedure takes 1 to 3 hours, depending on the type of heart rhythm disorder. It is usually performed under local anesthesia. After the procedure, the patient usually goes home the next day. After the procedure is performed, it is necessary to remember the follow-up visits – every three months in the first year after the procedure, then in the following twooch years every poł year. If the cryoablation procedure was successful, the patient may returnotion to previously performed activities – including, not infrequently, to sports activities.

Currently, there are no data to assess the risks associated with discontinuation of anticoagulant therapy after a successful atrial fibrillation cryoablation procedureow, therefore in the case of patientsow with a high risk of stroke, the doctor repeatedly recommends maintaining this treatment, despite the resolution of arrhythmias. Cryoablation procedure in the treatment of atrial fibrillationow is reimbursed by the National Health Fund.