Cryoballoon Ablation for Atrial Fibrillation — Video Interview with Dr. Wilber Su
January 25, 2013
- Summary: Dr. Wilber Su talks about cryoballoon ablation for atrial fibrillation as well as hybrid procedures.
- Reading and watching time is approximately 6 minutes
In this video interview, Dr. Wilber Su discusses cryoballoon ablation and what he has learned from doing over 600 of them. Dr. Su updates us on the evolving technology for cryballoon ablations, and the outcomes for patients who have cryoballoon ablations in comparison to radiofrequency ablation. He also talks about hybrid procedures that address atrial fibrillation from both the inside and the outside of the heart.
View the video interview with Dr. Su (approximately 5½ minutes)
About Wilber Su, MD, FHRS
Electrophysiologist, Phoenix, AZ
Mellanie True Hills: After more than 600 cryoballoon ablations, what have you learned?
Cryoballoon ablation has been an exciting technology for us. We’ve been dealing with afib ablation for many years now, and every year we continue to have improvements in our technology and to be able to find out safer and easier ways to cure afib. So cryoballoon came out from FDA approval approximately two years ago, and what we have learned is that this is truly a safer and more effective way of ablating atrial fibrillation.
In terms of the outcome, what we have seen is that the patients actually are recovering faster, and the healing process is quicker from the initial ablation, and the safety profile is definitely much improved compared to our prior experience.
One of the big advantages of cryoballoon ablation is that, because of the energy source differences, ablation with freezing – which means that the ablation catheter is frozen onto the tissue, so there’s less manipulation, we don’t need to fluoro when we’re doing the ablation – so after the initial learning experience from the operator, our typical fluoro time is less than five minutes of fluoroscopy used in each case. And the actual outcome is better than what our previous experience was with radiofrequency. The actual procedure time on average is about an hour to two hours of time.
MTH: What are your success rates for cryo?
With any technology, I think one has got to be careful in terms of looking at long term success rates. Because this technology is so new, we don’t have a lot of long term success rates to compare to, and that will come out over time. Acute success rates, looking at less than one year, we are still quoting the success rate of about 70% on average. I think overall it’s actually going to be much more improved. There are two iterations of cryoballoon, so even if we look at the cryoballoon data, such as the STOP-AF trial, we’re quoting a success rate of approximately 70%. But that’s actually with the older version of the balloon, and the much improved new balloon actually is technically easier for the operator to use, and the success rate in getting the pulmonary veins isolated electrically is actually much easier.
I think that there are a lot of new technologies of the horizon, and I think cryoballoon truly is one of the techniques that actually changed a lot of what we do because it truly is a safer and more effective way of doing pulmonary vein isolation as a cure for afib. We have a lot of happy patients who are off drugs, off Coumadin, and that’s really what we are there to do.
MTH: What about surgery? Are you doing hybrid procedures?
So, atrial fibrillation is such a large and wide spectrum of disease processes, so what I tell my patients is that atrial fibrillation is a wide spectrum of disease states with a common presentation. So paroxysmal, persistent, long-standing persistent are all very different. So what electrophysiologists do from the inside out, versus what surgeons do from the outside in, are very different, and can tackle different parts of the atrial fibrillation. So we have collaborative efforts, such as hybrid Maze, where we can simultaneously record and ablate from the inside while the surgeon works from the outside. We can confirm every surgical lesion, so that with one process, we can modify and change what causes and keeps afib going in one procedure.
For hybrid procedures, we have done approximately over 50 at this point. And these are all on patients who are very difficult to control— long-standing persistent afib, very large atria, and sometimes failed ablations. Looking at that experience, we know that one, can we get the atrial modification that’s similar to what we called the Cox IV maze in the past? I think that’s easily achievable with that. And the key is to do it minimally-invasively so that recovery is better, it’s off pump, meaning that we don’t need to stop the heart, and be able to achieve all of the surgical modification that’s needed so hopefully we can get rid of atrial fibrillation.
MTH: Dr. Su, Thank you for talking with us at American Heart Association.