When Angel Lynch first felt a strange flutter in her chest in 2009, she had no idea of the uncertainty to come. For the next several years, various medical professionals would struggle to address her sporadic but overwhelming heart palpitations, often leaving her dizzy and foggy while regularly leading to hospitalization.
Even after the Las Vegas resident was eventually diagnosed with atrial fibrillation, a common heart issue recognized by an irregular and rapid heart rate, numerous medications still failed to help.
“I was always anxious,” said Lynch, a registered nurse. “In the back of my mind, I constantly worried about where the closest ER or urgent care was located, in case I experienced another episode.”
A new option eventually became available for treating the potentially dangerous condition: Cryoablation. The procedure offered the potential for more effective results than traditional treatment, with the possibility of Lynch never experiencing her symptoms again — if all went well.
Facing the prospect of undergoing this new heart procedure earlier this year, the nurse was relieved that it would be performed by Dr. Dhiraj Narula, the very cardiologist she is assigned to work with every day at HealthCare Partners Cardiology.
“I was nervous undergoing a procedure that involved my heart, but knowing it was Dr. Narula gave me real comfort,” Lynch said.
She had good reason to trust him. In 2012, Dr. Narula conducted Nevada’s first-ever cryoablation procedure. Since then, HealthCare Partners Cardiology has conducted more than 120 cryoablation procedures, incorporating the procedure into regular treatment of atrial fibrillation.
“When we see positive results from a new procedure, we are always excited to offer it to more people,” Narula said.
Resulting in significantly improved results compared to prior treatment methods, Narula describes cryoablation as the future of atrial fibrillation treatment, and he is encouraged to see more hospitals across Southern Nevada providing it. This procedure could be the key to improving the lives of many people with stories similar to Lynch’s, he said.
HealthCare Partners Nevada played an integral role in bringing this procedure to Nevada, he said. “When new, useful technology is developed, we find a way to bring it to our patients as soon as practical,” Narula said.
A Common Issue
Atrial fibrillation remains the most common heart issue Narula sees at HealthCare Partners Cardiology, he said. During atrial fibrillation episodes, the heart’s upper two chambers beat irregularly and out of coordination with the lower two chambers, typically resulting in shortness of breath, weakness and heart palpitations.
The condition is common across the United States, Narula said. Although sometimes caused by genetics, atrial fibrillation often develops as a result of aging and poor lifestyle decisions, especially being overweight and not exercising.
“In the U.S., we have an aging population as well as a population becoming more obese, so atrial fibrillation is incredibly common and only increasing,” he said.
The condition can also be dangerous, Narula said. Although some individuals may not experience severe symptoms, atrial fibrillation can result in poor blood flow and cause a stroke, he said. In addition, the rapid heart rate induced by atrial fibrillation can sometimes cause congestive heart failure.
“On the whole, people with atrial fibrillation have a shorter lifespan than people without it,” he said.
A Constant Struggle
Lynch first began noticing symptoms while attending nursing school in Michigan. She would experience random, frightening episodes during which her heart would palpitate intensely, a sensation she compares to a fish flapping in her chest. During these episodes, she would feel short of breath and light-headed.
Over the next few years, Michigan health care providers prescribed a variety of medications to abate her heart palpitations. Her symptoms always returned, resulting in her being hospitalized repeatedly, sometimes for days at a time.
“It was really terrifying,” she said, remembering instances when she had to pull over while driving and call her husband to take her to the ER. “I have three kids, and I never wanted to drive with them in the car.”
The symptoms continued after she moved to Nevada in 2013. When she started working for HealthCare Partners Cardiology just over a year ago, she was eager to schedule an appointment with Narula.
“As his nurse, I often get feedback from patients and staff about how experienced and knowledgeable he is,” Lynch said. “He’s a great person and a great doctor, and I felt really comfortable with him.”
When Narula saw that medications weren’t working and suggested cryoablation, she was open to trying it.
“I know with any procedure there are risks, but all of the doctors I know of who perform the procedure have only positive things to say,” Lynch said.
Old Treatment Versus New
Traditionally, atrial fibrillation has been treated with medications and a procedure called radiofrequency ablation, Narula said.
This nonsurgical procedure, still the predominant treatment method across the U.S., requires experienced skill. The cardiologist performing the procedure must insert a long catheter tipped with an electrode into the patient’s body and guide it to the damaged heart tissue. Radiofrequency energy is then transmitted to the electrode to burn the heart tissue causing the symptoms, rendering it non-functional.
The procedure requires making numerous burns around an entire vein, with all of the burns connecting in a line, Narula said, which is no easy task when guiding an electrode from outside the body.
While largely successful, there are potential issues with radiofrequency, Narula said, including tissue healing from the burns, resulting in a return of symptoms.
“When this happens, we have to go back in with the catheter and touch it up,” Narula said.
This is why he took notice when he heard of studies using a new cryoablation balloon procedure to treat atrial fibrillation. This involves a catheter tipped with a balloon that freezes the heart tissue, instead of burning it.
“The cold energy is more appealing than the burning because it doesn’t disrupt the tissue, so there is less damage,” he said, adding that the balloon instantly freezes all of the tissue at once, reducing the risk of complications.
Bringing the procedure to Nevada took roughly a year. This included partnering with MountainView Hospital to purchase the new technology and Narula flying to Minneapolis for training on the procedure.
“We were cautiously optimistic,” Narula recalls, adding that HealthCare Partners Cardiology serendipitously began the program just when the latest generation of cryoablation technology became available. “We had good reason to believe we were providing something exciting and new, but there was no way to be completely certain this would be the wave of the future.”
Once his team viewed the positive results, however, there was no doubt about fully committing to cryoablation, he said. The cardiology division now conducts three to four procedures a week, and most are completely effective in eliminating atrial fibrillation.
They only need to redo a procedure for 15 percent of cryoablation patients, he adds, down from 35 percent of radiofrequency patients.
An Encouraging Future
After undergoing cryoablation in February, Lynch reports her symptoms are completely gone. She is no longer afraid of simple activities such as exercising or driving, she said.
“Overall I feel much better, physically and mentally,” she said. “Sometimes it can be scary doing something unknown, but you just have to trust your doctor.”
Cryoablation is also increasingly available in Southern Nevada now, offered at MountainView and Summerlin hospitals, with a program developing at Dignity Health-St. Rose Dominican Hospital.
While Dr. Narula believes cryoablation will increasingly play an important role in the treatment of atrial fibrillation around the world, he acknowledges it will take other organizations time to go through the same steps to obtain the new technology and undergo training.
“Change takes time,” he said. “It’s not just like turning a light switch on and off.”
But he is pleased with Southern Nevada leading this change. He looks forward to monitoring additional research that could further address atrial fibrillation, and he also hopes to see more efforts to educate Americans on lifestyle changes that could help prevent the issue.
“We would prefer to not have to treat it at all, if possible,” he said. “For now, it’s good to be on the leading edge of technology.”