CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 2, March/April 2014
88
AFRICA
Drug Trends in Cardiology
Cryoballoon ablation for atrial fibrillation is now possible in
South Africa
Dr Razeen Gopal, head of the Mediclinic
Panorama electrophysiology laboratory,
recently discussed various successful
procedures performed in their cardiac
unit over the past three years that have
radically changed the lifestyle of patients
with serious cardiac conditions. ‘Over
1 000 people, including children, have
benefitted from the advances in complex
ablation procedures as the unit has become
established as a centre of excellence,
keeping pace with what is happening in
the rest of the world’, he said.
The first person to undergo cryoballoon
ablation for atrial fibrillation was 35-year-
old Hein Pieterse from Malmesbury,
who suffered from paroxysmal atrial
fibrillation. Dr Gopal mentioned that what
touched him deeply was that although
Hein is a young man, he had difficulty
playing with his children because he was
never sure when a chaotic heart rhythm
might begin. He is now able to play golf,
as well as romp with his children, with a
regular heartbeat. The procedure was done
18 months ago and he has remained well.
The cryoballoon ablation was the first
operation of its kind performed in Africa.
Extremely low-temperature ablation
(effectively freezing) limits the activity
of the heart tissue at the base of the
pulmonary veins, which was triggering
fibrillation by means of additional
electrical signals.
The procedure involves insertion of
two catheters (first a sheath and then the
balloon inside it) from the groin through
the femoral vein into the right atrium, then
via small incisions, through the septum to
the left atrium. The cryoballoon is placed
at the base of one of the pulmonary veins.
Dye provides a good contrast to show
whether occlusion is complete, once the
balloon has been inflated and before
cooling. Freezing ablates the heart tissue
in a circular band exactly where the
malfunctioning cells are situated, thus
blocking the faulty electrical signals.
The procedure is repeated for the other
pulmonary veins.
As a surgeon who has experience
with both radiofrequency (heat) ablation
and cryotherapy, Dr Gopal explained
that in his personal opinion, cryoballoon
technology is safer because there is less
perforation (so less healthy heart tissue
is damaged), and the complication of
induction of new rhythm disturbances is
considerably reduced.
Both methods are used in the unit as
frozen balloon therapy is not suitable for
all conditions. Although it is not possible
to claim zero risk with any procedure,
patients in the unit have had no serious
complications and there have been no
deaths. Dr Gopal attributes this success
to the immense support of the dedicated
cardiac team.
Children
with
life-threatening
congenital cardiac conditions have also
been treated. Dr Gopal stressed that
drugs to regulate irregular heartbeat are
always the first-line treatment but if this is
unsuccessful, then ablation is considered.
Sarah Sallie (15) of Woodstock had
ventricular tachycardia and was unable to
manage the five-minute walk to school
without feeling exhausted. She now plays
hockey and netball and recently completed
a 10-km fun walk. Three children with
Wolff–Parkinson–White
syndrome,
Geatwin Riddles (11) of Riversdale,
Zanelle Francken (9) of Brackenfell and
Braydon Kilroe (8) of East London, have
undergone successful ablations to correct
the accessory electrical pathway defect,
and are now able to indulge in normal
activities such as cricket, rugby and ballet.
Another first for the unit was the
implant of a quadripolar left ventricular
pacemaker. Gerhardus van Zyl, who
had advanced heart failure, was the first
person in Africa to benefit from this most
up-to-date procedure, and remains well
almost a year later.
Dr Gopal, who trained in Belgium
and the UK, is actively involved in
electrophysiology training in South
Africa, as well as other African and
Middle East countries.
Anne Hahn
Dr Razeen Gopal addressing the media.
Dr Razeen Gopal with some of his patients. Back row:
Hein Pieterse, Sarah Sallie and Gerhardus van Zyl. Front:
Braydon Kilroe, Zanelle Francken and Geatwin Riddles.
