1st in Africa: AF treated with latest Cryoballoon technology

19th February 2015

March 2014. – History was made on the continent when a Cape Town heart specialist performed the first procedure using the latest version of a new procedure known as cryoballloon ablation to treat atrial fibrillation, a common heart rhythm disorder in people over 60 years.

A small balloon in the left side of the heart, new freezing technology, a highly trained specialist and a man from Malmesbury suffering from early stages of atrial fibrillation – these components all came together to create medical history.

Hein Pieterse (35) from Malmesbury became the first patient with atrial fibrillation (AF), also described as chaotic heartbeats, in Africa and the Middle East to undergo the latest version of cryoballoon ablation, a non-invasive procedure where extremely low temperatures are used to block defective electrical signals sparking irregular heartbeats.

The man who had changed Hein’s life, is Dr Razeen Gopal, one of only a few interventional electrophysiologists (cardiologists who super-specialised to diagnose and treat heart rhythm disorders) in South Africa. Dr Gopal, who trained at presitious academic institutions in the United Kingdom and Belgium, heads the electrophysiology unit at Panorama Mediclinic.

Since the first procedure, more patients have been treated successfully. For the first time, the success story is shared.

Untreated AF is strongly associated with a staggering 500-fold increase in risk for stroke. The incidence increases dramatically with age, with many South Africans over 65 years suffering from this heart rhythm defect. Effective treatment in the early stages of the condition – when the heart rhythm disorder is not yet persistent – with potent anticlotting medication and cryoballoon ablation, can lower the patient’s stroke risk dramatically.

AF ablation requires extreme competence and a well-trained and skilled electrophysiologist since the specialist physician has to – unlike other ablation procedures – enter and operate in the left heart chamber. In the hands of a skilled electrophysiologist, the procedure has a very low complication rate. However, in the hands of a cardiologist without experience and proper, international training, the procedure can be fatal.

Explaining cryoballoon ablation for treatment of atrial fibrillation

During cryoballoon ablation a very small balloon is inserted into the left heart chamber, where it is carefully positioned and cooled down to obliterate just the right heart tissue to block the defective electrical signals causing the chaotic heartbeats associated with AF. Since the defective electrical signals can no longer disrupt the heart rhythm, the rhythm reverts back to a normal rhythm and pace.

For Hein, the procedure was life changing.”Playing golf became a struggle, because of my irregular and chaotic heartbeats. I was diagnosed with paroxysmal AF, which meant that although my heart rhythm was normal at times, a chaotic and fast rhythm could erupt at any time. Every time my heart starting galloping at an irregular pace, I was aware that I am at high risk for a stroke or even death, and that was a scary thought. Since my procedure at the end of 2012, my heartbeat has been regular, even during high-intensity activity. Most of all, I enjoy playing golf again,” said Hein.

A safe(r) procedure

In the case of AF, less damage to heart tissue translates into a lower risk for creating new electrical focal areas. The risk for other complications is extremely low in the hands of a competent and skilled electrophysiologist.

Success rates with cryoballoon ablation in treatment of AF

Approximately 75% of patients with paroxysmal (intermittent) AF don’t need any anti-arrhythmia medication within one year post-procedure, while 60% of patients with persistent AF recover from AF after a series of ablations. These success rates achieved at Dr Gopal’s unit compare well with the very best internationally.

Ablation and children

Over the past decade, the success rate of other ablation techniques has also improved. Many children diagnosed with a heart thythm defect (in many cases congenital, and in many cases life threatening), can be treated with radiofrequency ablation and lead an active life.

Other ground-breaking procedures at the EP unit

Panorama Mediclinic’s EP unit, which participates in multiple international studies and projects, boasts even more medical firsts. Dr Gopal was the first specialist in Africa and the Middle East to implant the most updated version of a four-pole left ventricular pacemaker in a patient. This procedure was performed to treat a patient with advanced heart failure. The patient, Gerhardus van Zyl from Durbanville, is alive and well almost one year after this tricky procedure.

Compiled by Mari Hudson, director of The Good Doctors.

mhudson@thegooddocs.co.za