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CWT Keeps Abreast of New Technologies and Devices for Cardio Procedures

Courtesy of Milwaukee Journal-Sentinel - December 12, 2003.

Therapy Chills (and Heals) the Heart
Physicians tout freezing technique as safer,
easier than using heat

By John Fauber (jfauber@journalsentinel.com)
As Alice Pagels lay awake but mildly sedated earlier this week, doctors threaded a super-cold probe to her heart to deliver several minus 112-degree freezer burns to correct an irregular heartbeat that had been plaguing her for two years.

For years, burning scars onto the heart has been used to treat irregular heartbeats, called arrhythmias; but doctors at St. Luke's Medical Center in Milwaukee have become the first in Wisconsin to use cryoablation, a technique in which liquid nitrous oxide is pumped to the tip of a catheter to deliberately freeze and kill heart cells. Doctors say it is safer and easier to use than procedures that kill through heating.

"This is the first totally new way to provide therapy inside the heart," said Charles Lanzarotti, an electrophysiologist who since last month has used cryoablation on four patients at
St. Luke's Hospital. The technology may be of special interest to baby boomers who soon will be reaching that age when they will become most susceptible to arrhythmias. Already more than 2 million Americans have the most common arrhythmia, atrial fibrillation, and the number of new cases is expected to multiply.

"A-fib is the big kahuna because it's an extremely common arrhythmia," said Matthew Wolff, a cardiologist and director of the cardiac catheterization laboratory at the University of Wisconsin-Madison. "It's going to increase dramatically."

Pagels, 67, of Milwaukee, underwent a two-hour procedure Monday to correct an irregular heartbeat that doctors had been unable to fix with medication and other procedures. The condition would flare up when she exerted herself, such as walking up stairs or attending fitness classes, resulting in her becoming short of breath. "Your heart just races," she said just before undergoing the procedure. "I'm just hoping I can breathe normally and have a normal life." She was released from the hopital Tuesday.

Using a special probe that received U.S. Food and Drug Administration approval earlier this year, Lanzarotti created five freezing scars (areas of dead tissue) in her heart as a way to disrupt the faulty electrical signal. Some doctors think that cryoablation is likely to gain in popularity in the coming years.

"It's a huge advance," said Marilyn Ezri, an electrophysiologist and an associate professor of medicine at the Medical College of Wisconsin. One advantage is that, unlike traditional heat-based probes that can move around inside the heart, the cryo probe is easier to keep in place. "It's kind of like sticking your tongue on a popsicle," Ezri said.

Cryoablation devices work by super-cooling heart cells enough to kill the ones that are in the pathway of the faulty electrical signal that caused the irregular heartbeat. The probe actually causes ice to form inside and around the cells, which makes them burst. The one drawback is the equipment is expensive. For the moment, the probes, which cost about $2,000 each, must be thrown out after each use, she said. However, the main advantage to cryoablation is that it's safer than heating devices, said Cynthia Tracy, a professor of medicine at Georgetown University, who helped review the probe for the FDA. The heat-based probes can cause unwanted damage to nearby cells, resulting in higher rates of strokes and blockages of heart veins, as well as a condition known as complete heart block. In people with that condition, the desired electrical activity between the heart's upper and lower chambers is disrupted, requiring the permanent implantation of a pacemaker. Cryoablation "seems to have reasonably good efficacy." Tracy added.

In addition to using cryoablation to treat tachycardia cases, Lanzarotti said he expects to begin using the technology to treat a few atrial fibrillation cases in the coming months. "It's basically a whole new way to approach arrhythmia," he said.

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