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Treating irregular heartbeat with cryoablation

Physicians at Piedmont Heart Institute have been pioneering a relatively new treatment for patients with atrial fibrillation, the most common type of irregular heartbeat. The treatment, called cryoablation, has been successful in treating atrial fibrillation in patients who no longer responded to drug therapy.

“Atrial fibrillation is a totally disorganized and chaotic rhythm in the upper chambers of the heart,” explains Andy Wickliffe, M.D., an electrophysiologist at Piedmont Heart Institute Physicians.  “It tends to make the lower chambers, or ventricles, beat fast and irregularly.” Atrial fibrillation is typically first treated with drug therapy. Dr. Wickliffe says he cautions patients to remember that medication will not cure the condition. “What it does is reset the clock. It may buy us time and give patients a good quality of life for some number of years, but ultimately atrial fibrillation will win out over drug therapy,” he says. “Sometimes that can be within a day of starting drug therapy, sometimes it can be five to 10 years.

As long as a patient has a good quality of life, is tolerating the drugs and is maintaining normal rhythm, medication is perfectly appropriate therapy in the short to intermediate term.” For most patients, however, a long-term solution is necessary to effectively treat atrial fibrillation. Often, that treatment involves ablation. “If medication is either not tolerated or not successful in keeping the heart at a normal rhythm, typically the second line therapy, at least for selected patients, is a procedure called catheter ablation,” says Dr. Wickliffe. “There are multiple varieties and modalities of catheter ablation, but all of them share the idea of inserting a catheter, or long, skinny plastic tube, through the veins in the top of the leg and into the heart.

We are then able to either burn or freeze the tissue that seems to be causing the atrial fibrillation or that is keeping the a-fib going.” In the cryoablation process, a physician will use a 28-millimeter cryoballoon inserted into the body through a catheter to freeze large areas of tissue in the heart. “This is opposed to using a single-tip catheter to ablate that same area, which often takes a lot longer to do effectively,” he says. “The cryoballoon is also better at creating complete electrical isolation of the veins through radiofrequency, and we can usually do the procedure much more quickly.”

Dr. Wickliffe is part of a team at Piedmont Heart Institute that has been pioneering the new technology and is now teaching the method to physicians throughout the country. “Once a month, either Dr. Dan or I will travel up to Minneapolis to teach a course for other physicians, including our local physicians, who want to learn how to use this exciting new technique,” he says. “We feel like we’ve been in on the ground floor and have a great deal of experience with some of the tips and techniques that help the cryoablation procedure be more successful.” For more information about atrial fibrillation visit Piedmont Heart Institute.

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