"Please thank Dr. Merliss for giving me back my quality of life."
Just two weeks after undergoing a revolutionary new surgery to correct her atrial fibrillation, Miriam Davis, the first balloon cryoablation patient of cardiac electrophysiologist Andrew Merliss, MD, called to thank him for giving her the ability to enjoy life again.
Miriam's atrial fibrillation (A-Fib) caused her heart to beat rapidly, leaving her tired, anxious, unsettled - just uncomfortable overall. "I was so tired, but when I tried to sleep, it was like there was an elephant sitting on my chest."
So when Dr. Merliss told her about this new procedure, Miriam jumped in line to become the first patient in Nebraska to undergo balloon cryoablation.
Dr. Merliss is the only cardiologist in Nebraska to perform balloon cryoablation, and BryanLGH Medical Center is the only hospital in the state with the equipment. This procedure was just approved by the FDA in December, and Dr. Merliss performed his first balloon cryoablation at BryanLGH on March 4.
Atrial Fibrillation
Though there are many types of heart rhythm problems, Dr. Merliss calls atrial fibrillation the "Holy Grail" of electrophysiology because it is so difficult to manage and cure. There are so many potential triggers to consider - in some people it's simply drinking a cold beverage after exercise, for others it's coffee or alcohol, while others don't see any specific trigger points.
Though 6 percent of people 65 and over suffer from A-Fib, there is a whole subset of younger people who are troubled by the condition. Some are adrenaline affected, some are weight lifters, and some are long-distance runners.
Patients with A-Fib are not only significantly more at risk for stroke than the average person, but many, like Miriam,
experience symptoms which contribute to a poor quality of life. For some people, the symptoms come and go, whereas others have symptoms all the time. The American Heart Association recommends aggressive treatment for A-Fib regardless of whether symptoms are experienced. Though A-Fib is not preventable, most triggers can be managed through medication or ablation.
Ballon Cryoablation
Dr. Merliss - who's been performing ablations since 1995 - left his position at Harvard Medical School in 2002 to begin the radiofrequency ablation program at the BryanLGH Heart Institute (BHI). Before the program was fully developed, more severe cases were referred to major teaching hospitals. But now the program at BryanLGH is so sophisticated that few cases need to leave the area.
"We are on the forefront of technology and have the most up-to-date, state-of-the-art equipment and resources that rival those of anywhere else in the country. The hospital's support of cardiac physicians and the electrophysiology program allows us to continue to offer the most advanced procedures right here," says Dr. Merliss.
He explains that cryoablation itself has been around for some time as an energy source for freezing and has also been used with radiofrequency ablation procedures where the tip is cold instead of hot. What's exciting about this new procedure is balloon cryoablation's ability to treat the offending problem in a circumferential manner without gaps in coverage. (Imagine touching and correcting all areas in a circle at one time rather than having to treat hundreds of individual problem spots, a drawback to other ablation methods.)
Balloon cryoablation entails inserting a catheter into the left atrium of the heart and then sending -112 degrees
Fahrenheit coolant through a tiny balloon which has  been inflated after being introduced into the catheter. This procedure eliminates potential problems by scarring tissue that spreads electrical currents that can lead to A-Fib.
Dr. Merliss is excited about balloon cryoablation as it is lower risk and results in less procedure time than radiofrequency ablation. Nationwide, the procedure is experiencing an 80-85 percent success rate; however, like most surgeries, there are some risks.
"I am very selective about which patients receive the procedure as it is not for everyone. Some patients can be
managed with medication alone; others have too many other health problems or have had the condition for too long for this procedure to be effective," he notes.
Dr. Merliss says it's too early to know if balloon cryoablation will replace radiofrequency ablation: "Since it is so new, we don't have the five-year, 10-year studies to see long-term success rates, but we are excited about the prospects."
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