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Frozen to Life

Cryoablation -- the Freezing of Heart Tissue -- Can Stop Some Arrhythmias Cold

By Sandra G. Boodman
Washington Post Staff Writer
Tuesday, August 3, 2004; Page HE01

The catheter that Northern Virginia cardiologist Margaret H. Bell threaded into Johnathan Suthard's beating heart was as thin as a strand of linguini, its tip loaded with pressurized frozen nitrous oxide. The solution it would emit was chilled to minus-75 degrees Celsius, a temperature equivalent to the coldest recorded on the Siberian steppes.

Applied precisely to specific spots on the upper right chamber of his heart, the suspected source of Johnathan's potentially fatal heart arrhythmias, the liquid literally froze the targeted tissues to death. The procedure Bell and her partner performed last May known as cardiac cryoablation worked perfectly, restoring the 13-year-old's too-fast heart rate to a normal rhythm.

Cardiac cryoablation has enabled Jonathan Suthard of Manassas Park, shown here with his parents, Ray and Deborah Suthard, to cure his arrythmia and become active in sports. (Jahi Chikwendiu - The Washington Post)

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Doctors at Inova Fairfax Hospital were the first in the Washington area to perform cardiac cryoablation, using a device approved last year by the U.S. Food and Drug Administration (FDA). Specialists at Children's National Medical Center in the District are set to offer it, officials there said, and pediatric cardiac experts predict the procedure will be widely used by next year.

Now liberated from the constraints that have circumscribed his life since age 8, the rising ninth-grader from Manassas Park is immersed in football practice and plans to try out for the track and basketball teams.

And for the first time in six years, his mother says, she is able to relax, without fearing that he might suddenly collapse or forget to take the drug that stabilized his heart rate, but made him dizzy and sluggish. Once, after Johnathan missed two doses, he had to be rushed to the emergency room.

"A lot of the time he couldn't even feel his heart going into arrhythmia," Deborah Suthard said. Her son, she said, desperately wanted to play sports, and his doctors agreed to let him, with certain restrictions.

"I'd stand on the sidelines watching him," Suthard recalled, "and I was just scared to death."

Two years ago Bell tried to treat the boy's heartbeat problem with "radiofrequency ablation," a procedure that uses a heat-tipped catheter to destroy cardiac tissue responsible for the abnormal rhythm.

That procedure had to be aborted because doctors decided after mapping the area that it was too close to the heart's normal conducting system. They worried that if they proceeded they might be forced to implant a pacemaker, a device cardiologists assiduously avoid using in pediatric patients.

A Safer Way

In the past eight months Bell and her partners have performed about 50 cryoablations at Inova Fairfax, about half on pediatric patients. None of the patients has subsequently required a pacemaker or suffered a major complication, Bell said.

"I was an early adopter because this procedure has such a good safety profile," said Phil Saul, chief of pediatric cardiac surgery at the Medical University of South Carolina in Charleston. Saul pioneered ablation procedures a decade ago when he was at Children's Hospital in Boston.

Bell, 43, belongs to a tiny fraternity of physicians -- there are about 100 in the United States -- known as pediatric cardiac electrophysiologists: cardiologists who specialize in treating children with disorders of the heart's electrical system. This system controls the heart rate and provides the energy necessary for the organ's pumping action. Arrhythmia -- a fast, sometimes erratic heartbeat -- can occur when the normal conduction pathways are disrupted.

Like Saul, Bell waited eagerly for the FDA to approve the cryoablation catheter after studies indicated it was safer than radiofrequency ablation and could help patients like Johnathan Suthard.

Cryoablation currently is approved only for patients whose arrhythmias begin in the upper right chamber of the heart near the AV node, a condition called supraventricular tachycardia, or SVT. Children who develop a fast heartbeat are usually born with the condition. In rare cases like Johnathan's, there is a hereditary cause.

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