Cryoablation
Encyclopedia
Cryoablation is a process that uses extreme cold (cryo) to remove tissue (ablation).
Cryoablation is used in a variety of clinical applications using hollow needles (cryoprobes) through which cooled, thermally conductive, fluids are circulated. Cryoprobes are inserted into or placed adjacent to tissue which is determined to be diseased in such a way that ablation will provide correction yielding benefit to the patient. When the probes are in place, the cryogenic freezing unit removes heat ("cools") from the tip of the probe and by extension from the surrounding tissues.
Ablation occurs in tissue that has been frozen by at least three mechanisms: (1) formation of ice crystals within cells thereby disrupting membranes, and interrupting cellular metabolism among other processes; (2) coagulation of blood thereby interrupting bloodflow to the tissue in turn causing ischemia and cell death; and (3) induction of apoptosis
, the so-called programmed cell death cascade.
The most common application of cryoablation is to ablate solid tumors found in the lung, liver, breast, kidney and prostate. The use in prostate and renal cryoablation are the most common. Although sometimes applied through laparoscopic or open surgical approaches, most often cryoablation is performed percutaneously (through the skin and into the target tissue containing the tumor).
Renal cryoablation is highly effective in smaller tumors found in the kidney and adrenal gland. The results are excellent and spare surrounding tissues from ablation.
A catheter is a very thin tube that is inserted into a vein in the patient’s leg and threaded to the heart where it delivers energy to treat the patient’s arrhythmia. In surgical procedures, a flexible probe is used directly on an exposed heart to apply the energy that interrupts the arrhythmia. By cooling the tip of a cryoablation catheter (cardiology
) or probe (heart surgery) to sub-zero temperatures, the cells in the heart responsible for conducting the arrhythmia are altered so that they no longer conduct electrical impulses.
s of the breast. Fibroadenomas are benign
breast tumors that are found in approximately 10% of women (primarily ages 15-30).
In this FDA-approved procedure, an ultrasound-guided probe is inserted into the fibroadenoma and extremely cold temperatures are then used to destroy the abnormal cells;over time the cells are reabsorbed into the body. The procedure can be performed in a doctor's office setting with local anesthesia and leaves very little scarring compared to open surgical procedures.
Currently, only Sanarus Technologies
, LLC in Pleasanton
, California
, manufactures and sells cryoablation treatment systems for breast care.
This is a much newer treatment for supraventricular tachycardia (SVT) involving the atrioventicular (AV) node directly. SVT involving the AV node is often a contraindication for using radiofrequency ablation because of the risk of injuring the AV node, forcing patients to receive a permanent pacemaker. With cryoablation, areas of tissue can be mapped by limited, reversible, freezing (e.g. to -10 C). If the result is undesirable, the tissue can be rewarmed without permanent damage. Otherwise, the tissue can be permanently ablated by freezing it to a lower temperature (e.g. -73 C).
This therapy has revolutionized AV nodal reentrant tachycardia (AVNRT) and other AV nodal tachyarrhythmias. It has allowed people who were otherwise not a candidate for radiofrequency ablation to have a chance at having their problem cured. This technology was pioneered at Miami Valley Hospital in Dayton, Ohio by Dr. Mark Krebs, Matthew Hoskins RN, BSN, and Ken Peterman RN, BSN. in 2004. These electrophysiology experts were successful in curing the first 12 patients that they treated at their facility. Many others have been successfully treated since and they continue their work in the field.
Cryoablation for AVNRT and other arrhythmias do have some drawbacks. A recent study concluded that procedure times are slightly higher on average for cryoablation than for traditional Radio-Frequency (heat-based) ablations. Also, higher rate of equipment failures were recorded using this technique. Finally, even though short term success rate is equivalent to RF treatments, Cryoablation appears to have a significantly higher long term recurrence rate.
is able to produce a temporary electrical block by cooling down the tissue believed to be conducting the arrhythmia. This allows the physician to make sure this is the right site before permanently disabling it. The ability to test a site in this way is referred to as site testing or cryomapping.
When ablating tissue near the AV node (a special conduction center that carries electrical impulses from the
atria to the ventricles), there is a risk of producing heart block - that is, normal conduction from the atria
cannot be transmitted to the ventricles. Freezing tissue near the AV node is less likely to provoke irreversible heart
block than ablating it with heat.
involves the use of freezing techniques for the treatment of arrhythmias during surgery.
A physician may recommend cryosurgery being used during the course of heart surgery as a secondary procedure to treat any arrhythmia that was present or that may appear during the primary openchest procedure. The most common heart operations in which cryosurgery may be used in this way are mitral valve repair
s and coronary artery bypass grafting. During the procedure, a flexible cryoprobe is placed on or around the heart and delivers cold energy that disables tissue responsible for conducting the arrhythmia.
Cryoablation is used in a variety of clinical applications using hollow needles (cryoprobes) through which cooled, thermally conductive, fluids are circulated. Cryoprobes are inserted into or placed adjacent to tissue which is determined to be diseased in such a way that ablation will provide correction yielding benefit to the patient. When the probes are in place, the cryogenic freezing unit removes heat ("cools") from the tip of the probe and by extension from the surrounding tissues.
Ablation occurs in tissue that has been frozen by at least three mechanisms: (1) formation of ice crystals within cells thereby disrupting membranes, and interrupting cellular metabolism among other processes; (2) coagulation of blood thereby interrupting bloodflow to the tissue in turn causing ischemia and cell death; and (3) induction of apoptosis
Apoptosis
Apoptosis is the process of programmed cell death that may occur in multicellular organisms. Biochemical events lead to characteristic cell changes and death. These changes include blebbing, cell shrinkage, nuclear fragmentation, chromatin condensation, and chromosomal DNA fragmentation...
, the so-called programmed cell death cascade.
The most common application of cryoablation is to ablate solid tumors found in the lung, liver, breast, kidney and prostate. The use in prostate and renal cryoablation are the most common. Although sometimes applied through laparoscopic or open surgical approaches, most often cryoablation is performed percutaneously (through the skin and into the target tissue containing the tumor).
Prostate cryoablation
Prostate cryoablation is highly effective but, as with any prostate removal process, also can result in impotence. Prostate cryoablation is used in three patient categories: (1) as primary therapy in patients for whom sexual function is less important or who are poor candidates for radical retropubic prostatectomy (RRP, surgical removal of the prostate); (2) as salvage therapy in patients who have failed brachytherapy (the use of implanted radioactive "seeds" placed within the prostate) or external beam radiation therapy (EBRT); and (3) focal therapy for smaller, discrete tumors in younger patients.Renal cryoablation is highly effective in smaller tumors found in the kidney and adrenal gland. The results are excellent and spare surrounding tissues from ablation.
Cardiac cryoablation
Another type of cryoablation is used to restore normal electrical conduction by freezing tissue or heart pathways that interfere with the normal distribution of the heart’s electrical impulses. Cryoablation is used in two types of intervention for the treatment of arrhythmias: (1) catheter-based procedures and (2) surgical operations.A catheter is a very thin tube that is inserted into a vein in the patient’s leg and threaded to the heart where it delivers energy to treat the patient’s arrhythmia. In surgical procedures, a flexible probe is used directly on an exposed heart to apply the energy that interrupts the arrhythmia. By cooling the tip of a cryoablation catheter (cardiology
Cardiology
Cardiology is a medical specialty dealing with disorders of the heart . The field includes diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology...
) or probe (heart surgery) to sub-zero temperatures, the cells in the heart responsible for conducting the arrhythmia are altered so that they no longer conduct electrical impulses.
Fibroadenoma cryoablation
Cryoablation is also currently being used to treat fibroadenomaFibroadenoma
Fibroadenomas of the breast, are lumps composed of fibrous and glandular tissue. Because breast cancer can also appear as a lump, doctors may recommend a tissue sample to rule out cancer in older patients...
s of the breast. Fibroadenomas are benign
Benign
A benign tumor is a tumor that lacks the ability to metastasize. Common examples of benign tumors include moles and uterine fibroids.The term "benign" implies a mild and nonprogressive disease. Indeed, many kinds of benign tumors are harmless to human health...
breast tumors that are found in approximately 10% of women (primarily ages 15-30).
In this FDA-approved procedure, an ultrasound-guided probe is inserted into the fibroadenoma and extremely cold temperatures are then used to destroy the abnormal cells;over time the cells are reabsorbed into the body. The procedure can be performed in a doctor's office setting with local anesthesia and leaves very little scarring compared to open surgical procedures.
Currently, only Sanarus Technologies
Sanarus Technologies
Sanarus Technologies is a medical device company that develops and markets minimally-invasive, office-based breast care diagnosis and treatment solutions to patients and physicians. The company provides cryoablation technology that is used to freeze tissue for diagnostic and therapeutic breast care...
, LLC in Pleasanton
Pleasanton, California
Pleasanton is a city in Alameda County, California, incorporated in 1894. It is a suburb in the San Francisco Bay Area located about east of Oakland, and west of Livermore. The population was 70,285 at the 2010 census. In 2005 and 2007, Pleasanton was ranked the wealthiest middle-sized city in...
, California
California
California is a state located on the West Coast of the United States. It is by far the most populous U.S. state, and the third-largest by land area...
, manufactures and sells cryoablation treatment systems for breast care.
Catheter-based procedures
Different catheter-based ablation techniques may be used and they generally fall into two categories: (1) cold-based procedures where tissue cooling is used to treat the arrhythmia, and (2) heat-based procedures where high temperature is used to alter the abnormal conductive tissue in the heart.Cryoablation
Cold temperatures are used in cryoablation to chill or freeze cells that conduct abnormal heart rhythms. The catheter removes heat from the tissue to cool it to temperatures as low as -75°C. This causes localized scarring, which cuts undesired conduction paths.This is a much newer treatment for supraventricular tachycardia (SVT) involving the atrioventicular (AV) node directly. SVT involving the AV node is often a contraindication for using radiofrequency ablation because of the risk of injuring the AV node, forcing patients to receive a permanent pacemaker. With cryoablation, areas of tissue can be mapped by limited, reversible, freezing (e.g. to -10 C). If the result is undesirable, the tissue can be rewarmed without permanent damage. Otherwise, the tissue can be permanently ablated by freezing it to a lower temperature (e.g. -73 C).
This therapy has revolutionized AV nodal reentrant tachycardia (AVNRT) and other AV nodal tachyarrhythmias. It has allowed people who were otherwise not a candidate for radiofrequency ablation to have a chance at having their problem cured. This technology was pioneered at Miami Valley Hospital in Dayton, Ohio by Dr. Mark Krebs, Matthew Hoskins RN, BSN, and Ken Peterman RN, BSN. in 2004. These electrophysiology experts were successful in curing the first 12 patients that they treated at their facility. Many others have been successfully treated since and they continue their work in the field.
Cryoablation for AVNRT and other arrhythmias do have some drawbacks. A recent study concluded that procedure times are slightly higher on average for cryoablation than for traditional Radio-Frequency (heat-based) ablations. Also, higher rate of equipment failures were recorded using this technique. Finally, even though short term success rate is equivalent to RF treatments, Cryoablation appears to have a significantly higher long term recurrence rate.
Site testing
CryotherapyCryotherapy
Cryotherapy is the local or general use of low temperatures in medical therapy or the removal of heat from a body part. The term "cryotherapy" comes from the Greek cryo meaning cold and the word therapy meaning cure...
is able to produce a temporary electrical block by cooling down the tissue believed to be conducting the arrhythmia. This allows the physician to make sure this is the right site before permanently disabling it. The ability to test a site in this way is referred to as site testing or cryomapping.
When ablating tissue near the AV node (a special conduction center that carries electrical impulses from the
atria to the ventricles), there is a risk of producing heart block - that is, normal conduction from the atria
cannot be transmitted to the ventricles. Freezing tissue near the AV node is less likely to provoke irreversible heart
block than ablating it with heat.
Surgical procedures
As in catheter-based procedures, techniques using heating or cooling temperatures may be used to treat arrhythmias during heart surgery. Techniques also exist where incisions are used in the open heart to interrupt abnormal electrical conduction (Maze procedure). CryosurgeryCryosurgery
Cryosurgery is the application of extreme cold to destroy abnormal or diseased tissue. The term comes from the Greek words cryo and surgery meaning "hand work" or "handiwork"....
involves the use of freezing techniques for the treatment of arrhythmias during surgery.
A physician may recommend cryosurgery being used during the course of heart surgery as a secondary procedure to treat any arrhythmia that was present or that may appear during the primary openchest procedure. The most common heart operations in which cryosurgery may be used in this way are mitral valve repair
Mitral valve repair
Mitral valve repair is a cardiac surgery procedure performed by cardiac surgeons to treat stenosis or regurgitation of the mitral valve. The mitral valve is the "inflow valve" for the left side of the heart. Blood flows from the lungs, where it picks up oxygen, through the pulmonary veins, to the...
s and coronary artery bypass grafting. During the procedure, a flexible cryoprobe is placed on or around the heart and delivers cold energy that disables tissue responsible for conducting the arrhythmia.