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Prakash Chandran: Cryoablation is a treatment to kill electrically active heart tissue that causes arrhythmias. And today we're gonna learn all about it. Joining us is Dr. Cary Rose, an electrophysiologist at San Juan Regional Medical Center. This is Celebrate Health, the podcast from San Juan Regional Medical Center. I'm your host, Prakash Chandran. So Dr. Rose, thank you so much for joining us. I truly appreciate your time. I wanted to get started by asking what exactly is Cryoablation and when do you need it?

Dr. Cary Rose: Thank you. Great to be here. Cryoablation is a really, really neat new tool that we use, in, cardiology to help remove damaged electrical tissue from the heart, which causes atrial fibrillation. It is the newest of the tools that we use for what's called ablation. There are two types of ablations. One uses heat and one uses cool. The heart really likes cool rather than heat. It causes a much better lesion, and in doing so, it can help you cure arrhythmias. And the main one that we use it for is for the most common arrhythmia in America, also known, of course, atrial fibrillation or AFib.

Prakash Chandran: Yeah. You know, I actually heard that you have a quote around what A Fib does to the heart. Would you mind sharing that?

Dr. Cary Rose: Absolutely, my privilege. What I try to explain to what atrial fibrillation does to the heart, what people don't realize is, is atrial fibrillation is an electrical cancer of the heart. Let me say that again. It is an electrical cancer of the heart. The longer a person is in AFib, the worse the heart gets and the less and less chance you have of getting them back into normal rhythm, which is why we tell people, if you think you have AFib, get to a cardiologist immediately. Don't say, oh, it'll be fine, or, oh, it's not a big deal. It is a big deal. It doesn't go away and it only gets worse over time.

Prakash Chandran: Yeah. I'm so glad you shared that. That's actually the first time I've heard that and really kind of creates some gravity around how important it is to get it checked out. Let's move back to cry ablation itself. Now, you talked at a high level about the cooler ablation being better, but can you talk specifically about this procedure what exactly treats and the benefits?

Dr. Cary Rose: Absolutely. Well first you can't really talk about Cryoablation without at least talking a little bit more about atrial fibrillation because you see these things on TV and these commercials, but it doesn't really lend credence to what it really is. Atrial fibrillation is the most common arrhythmia in America. We're about 1 million Americans have been affected with covid, for example. There are 12 to 15 million Americans affected with atrial fibrillation, and you just have to let your mind wonder how many people that is. Atrial fibrillation, affects people young, medium, age, and older, and we're getting better and better at diagnosing it and figuring out what causes it.

The problem with AFib is it does several things with the heart. Number one, the irregular heart rhythm robs you of your natural heartbeat, and it robs you a lot of your energy and your desire to do things. In addition to that, atrial fibrillation is one of the leading causes of stroke, especially in people with certain risk factors such as diabetes, heart disease, prior heart disease, heart attacks, that sort of thing. We have a scale that we use and we give a certain number of points. The point is atrial fibrillation is not something to be ignored. It's not something you need to live with, but it's very important to know that we have treatments for it. Atrial fibrillation used to be treated with medications. Anti arythmic medications.

And then we moved on to develop ablation for AFib. And this is something that the pioneers of this started 10 or 20 years ago. AFib ablations have come a long way in the past 10 to 15 years. the older ablations were heat ablations, also known as RF ablations, and many doctors still use them today with good success. However, a newer technology that's been around for a few years is the cryoablation, and we are now in the latest iteration, the second generation of cryo. What cryoablation is where we take a round balloon and it is a super cool balloon, and we take that balloon and place it in the heart in the left atrium, and we freeze the tissue that's involved, with creating atrial fibrillation, we freeze it completely.

The heart loves this because it results in a very nice lesion. It's not burning the heart in any way, and the heart, seems to really react very well to this. And the success rate of an atrial fibrillation ablation with cryo, with something called paroxysmal AFib is estimated now between about 80 and 90%. This is an extremely high number and that's an improvement on previous, numbers, which is more like 60 to 70%. And with each year we get better. The more cases we do, the better we get. And we have a real serious chance soon of maybe, hopefully using that word cure, curing atrial fibrillation. And that's something we all hope for.

Prakash Chandran: Wow. So can you talk a little bit more about the dynamics around how it is performed or where it's performed and how long it takes?

Dr. Cary Rose: Cryoablation is performed by, doctors like myself who are board certified and trained electrophysiologist. I believe that a of ablation is probably about the pinnacle of all ablations because it is something that, requires a lot of training and a lot of understanding of the anatomy of the heart and knowing where you are at all times. the best part about Cryoablation for AFib is it is not surgery. There are no stitches. There is no cutting, there's no knife. You don't open a person's chest. The best part about this entire procedure is that it's similar to a heart cath, where we basically put catheters in your legs up in the veins of your legs.

The veins go up into the heart, at this point we're on the right side of the heart, and then we move across to the left side of the heart. When we're in the left side, that's where the veins are, the pulmonary veins that allow blood to come from back from the lungs and give oxygenated blood to the body. We all learn that in high school, but what we do is we take the cryo balloon and we basically freeze all four of these veins, which hopefully will prevent any further of these electrical signals from reaching the rest of the heart. It is a terrific procedure where we visualize the heart in three dimensional angles at all times.

We use what's called fluoroscopy and a really neat new technique called intra cardiac echocardiography, where we actually do an echo from the inside of the heart. Which is really amazing. And then when we're done, we simply pull the catheters right back out, and guess what you get? You get a big bandaid. That's it. And then you heal up like nothing ever happened because you didn't actually have surgery, the recovery time is very short and people tend to do very well.

Prakash Chandran: Yeah. That's incredible. I was just gonna ask you about the recovery time, but it seems like you can just walk out the same day. There's a bandaid and there doesn't seem to be any like side effects to it. Right?

Dr. Cary Rose: Well, something like that. Typically people are kept overnight, for observation, for these types of things. Yes, you have a bandaid. We actually encourage people to walk around a few hours after the procedure. obviously there are restrictions. No heavy lifting, keeping it dry for a few days, but typically speaking, except for some generalized soreness, that everybody would get, people are pretty happy because there sutures. There's no stitches, there's no cutting. There's nothing like that. People don't have that kind of pain. There's no postoperative type pain. That's the best part about this procedure, and that's what makes us all very excited, is that we call this a minimally invasive procedure.

We're literally performing the equivalent of surgery, but we're not actually using a sco. And that is the most amazing thing that we can make such a difference in somebody's heart. And all we have to do at the end is give them two bandaids or something like that. obviously there's a healing period afterwards. Obviously there's a period of time where they will continue their medications, but typically speaking, most patients say the same thing to me. Gosh, I didn't have any pain at all. I woke up thinking I was gonna be in a lot of pain. This is great. I don't feel anything. And when you hear something like that from a patient, it really makes you feel pretty good.

Prakash Chandran: Yeah, that is amazing. So tell me, is this like a one time thing or will a patient kind of need to get repeated treatments?

Dr. Cary Rose: That is an excellent question and that's something we are still, developing. I can tell you that there's different types of atrial fibrillation far beyond this, the scope of this, but, there's certain types of people who have af. Now and again, they go into it and they come out of it. That's called paroxysmal. There's other types of AFib where people have had AFib for a much longer period of time. Studies have shown that the people who have AFib the shortest do the best. that's why we tell people, don't wait. Don't wait until your atrial fibrillation gets worse, because then it becomes harder and harder to do the ablation type procedure because more of the heart becomes what we call an AFib heart.

But again, do people need more than one procedure? Some people do. People who have certain risk factors, for example, sleep apnea, I hate to say this, but, obesity, sleep apnea, the two big ones. People who have lung disease and people who have real dysfunction. These four things, all four of these things predispose somebody to going back into the arrhythmia. In many cases, it's just a reconnection of one of those veins we talked about. So we go in and we do what's called a touchup. We go in and we touch up the vein and refreeze it, for example, And we also map different parts of the atrium, and after we map it, we find other signals and we ablate that too.

That's called the posterior wall. That's what we do in more persistent types. But again, with every year that passes by and all of the studies that we do, we get better and better with what we do. And there are a lot of different types of ablations right now for AFib that's on the horizon coming out there. I personally enjoy the cryo because we have a very high success rate and. fortunately with cryo, the studies have all shown that there is a significantly reduced risk of coming back to the hospital and a significantly reduced risk of recurrence.

Prakash Chandran: So, you talked about the millions of people that AFib affects. Is everyone a candidate for this cryoablation? Like how do you determine, who gets it and who gets another set of treatment?

Dr. Cary Rose: There are a lot of people that have AFib, but not everyone with AFib needs an ablation, number one, for example. Often people can be treated with medications. People who have AFib once a year for half an hour don't need an ablation, obviously other people who are, for example, medically, they're older. They have a lot of concurrent disease, pulmonary disease, people who are sedentary, wheelchair bound, or even bedbound. These types of patients would not benefit from an aFib ablation because it really wouldn't make much of a difference in their quality of life.

So no, not everyone gets an aFib ablation. also as I mentioned before, patients with severe sleep apnea and obesity, we have to get those problems under control before we do an ablation. Otherwise it will recur. sleep apnea is a tremendous. Creator of medical problems, but especially at night when it increases the pressures in your heart, especially in your left atrium where AFib comes from and then all of a sudden your AFib comes back. Obesity the same thing. And so weight loss, exercise and diet is extremely important. Control of sleep apnea with medication and with the CPAP maps, also very important.

And then finally, control of other things, pulmonary disease, stopping smoking, eating healthy. These are all very, very important and helping us, doing the right thing for the right patient.

Prakash Chandran: So, Dr. Rose, we've talked a lot about the importance of going in if you feel like you have AFib, but we haven't talked about the testing mechanism itself. So for me, I have an Apple watch that's supposed to tell me whether or not I have it. But what is your recommendation around how people get tested and when they should come in?

Dr. Cary Rose: Well, to answer your question, you mentioned Apple watches before, more and more people seem to have these things. Now these are not foolproof and there's a lot of controversy, but the Apple Watch is often, in many cases now becoming the chief complaint of the patient is, I came in because my Apple Watch told me to. Which is fine because that actually leads us, because many times these people don't even know they have AFib because many cases they haven't felt it. So that's one option. getting yourself checked out by a primary doctor at least once a year, having them do an EKG on you. Just, things like that is very, very important.

You don't know what you don't know, but it's always important to maintain your health and especially as you get older, if you have family members with AFib, very important AFib, there are many types that are genetic. So if you have a mother and a father who both had AFib when they were in their fifties, the chances are you might be likely you're gonna have AFib as well. So getting yourself checked out with a monitor, an EKG is very, very important. And especially if you have symptoms, if you have those palpitations where you wake up at night and you go, Gosh, my heart's beating really fast.

Or you get short of breath where you're outside and you're doing things and you say, Gosh, feels so short of breath, it feels like my heart's beating fast. All these types of things, could be indicative of an arrhythmia of the heart. And since AFib is so common, especially as we get older, we worry about AFib. And we're getting better and better at diagnosing it. Again, you can't argue with those kinds of numbers. I mean, and we don't even know if the numbers are correct. It could be even higher, we really don't know.

Prakash Chandran: Yeah, totally. Well, this has been a fascinating conversation and just a good reminder for people to stay proactive around AFib. there's a couple different ways. Whether you're kind of experiencing symptoms or wearing an Apple watch, that you experience or you might think that you have it, but the most important thing is to go to your primary care physician and they'll refer you on to a cardiologist. Just before we close here today, Dr. Rose, is there anything else that you'd like to share with us today?

Dr. Cary Rose: Absolutely. Well first, again, hospitals like ours, a lot of hospitals now are becoming more and more equipped to do these types of procedures and so is ours here at San Juan Regional. We're doing a lot of these procedures here and we can help a lot of people. So, always open to getting as many people as possible and, Seeing we can help them. If I could just give a quick shout out, cause I have several members of my family are in the medical field or want to be, but I gotta give a shout out to my girlfriend Terry in Jacksonville. The hurricane missed us, thank God. And, also my kids. My daughter Josie is a sophomore at UCLA and she's premed, UCLA is undefeated. So very excited. I went to ucla, so, go Bruins. And my son, Max is a freshman at Iowa State, the Cyclones. So, shout out to my family. I wouldn't be here without my family. I love him very much.

Prakash Chandran: I love that. Dr. Rose, thank you so much for that. Hello, Terry, Josie and Max and Dr. Rose. Thank you so much for being here with us today.

Dr. Cary Rose: The privilege is mine. Thank you so much.

Prakash Chandran: That was Dr.Cary Rose, an electrophysiologist at San Juan Regional Medical Center. Thank you all for listening to Celebrate Health, the podcast from San Juan Regional Medical Center. For more information, you can visit sanjuanregional.com. I'm your host Prakash Chandran. Thanks again for listening and we'll talk again soon.