The daily hikes of five or six miles were a way of life.
Martin Ehresman would take his two Siberian huskies out for walks around his Greenwood home, keeping pace with the large dogs and holding them back from chasing the rabbits and cats they encountered.
When he had more time, all three would travel to Brown County or other state parks to tackle steep trails for hours at a time.
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But about two years ago, his body refused to cooperate.
“It wasn’t fun anymore. I couldn’t go very far without resting, my arms started hurting, and I didn’t like it,” he said.
Ehresman’s erratic and weakening heart started robbing him of way of life. Not until doctors performed a breakthrough medical treatment was he able to regain the lifestyle he thought he had lost.
In October, Ehresman became one of the first patients in Indiana to undergo cryoablation to correct his irregular heartbeat. Surgeons used a balloon catheter filled with nitrous oxide to deep-freeze tiny pieces of heart tissue causing the heart to malfunction.
“When you freeze it, you form icicles in the tissue, which disrupts the cells permanently to create scar,” said Dr. Gopi Dandamudi, a cardiologist and program director of the Indiana University Health Atrial Fibrillation Center at IU Health Methodist Hospital. “It seems to have good outcomes in terms of doing the procedure faster, safer and more effectively.”
Ehresman, 66, had never suffered from heart problems in the past. But two or three years ago, he was at his annual physical when the doctor noticed his pulse was erratic.
The doctor recommended he see a cardiologist at Indiana University Health Methodist Hospital, who diagnosed it as atrial fibrillation: a chronic condition where electrical signals in the heart cause it beat irregularly.
“There were times before when I’d had some spells: I kind of felt bad and didn’t have any energy. In retrospect, that was me going into atrial fibrillation and going out of it,” he said.
Atrial fibrillation occurs when disorganized electrical signals cause the heart’s two upper chambers to contract very quickly and unpredictably, according to the National Heart, Lung and Blood Institute.
Blood pools in the upper chambers of the heart, and is not pumped completely into the lower chambers. The condition can lead to an increased risk of stroke. In some people, atrial fibrillation can cause chest pain or heart failure, according to the National Heart, Lung and Blood Institute.
“Atrial fibrillation is a chronic disease. It’s not just an arrhythmia that you take care of and is permanently cured,” Dandamudi said. “It’s a disease just like high blood pressure or diabetes. You try to address it as early in the disease as possible, and slow down the progression. It’s a chronic management of an illness.”
After his diagnosis, the issue was sporadic at first for Ehresman. His heart would wobble and beat irregularly for a short period, then regain its normal rhythm. He was able to control it with medication.
But after about a year, his heart was in atrial fibrillation constantly. He had to stop repeatedly even out on simple walks. He stopped camping and put off a number of nature trips he had planned.
“That took a lot of my energy away. I couldn’t do the normal daily activities that I had done,” he said.
Explaining to his cardiologist that on hikes and walks he was regularly needing to stop and rest, his doctor told him he was too young to be dealing with those issues. They started talking about medical procedures to remedy the problem.
In the past, cardiologists found the best treatment to be ablation. They would run a small device through the blood vessels in the leg, then use radio frequency energy to burn away the minuscule pieces of tissue causing the electrical imbalance.
The method was effective, but time consuming. Cardiologists had to continually circle the interior of the vein to hit each individual piece of tissue, dragging the procedure out for seven or eight hours.
Cryoablation was created as an alternative. Similar to traditional ablation, cardiologists use 3-D mapping to guide a balloon catheter filled with nitrous oxide from the groin to the heart.
Advanced imaging allows technicians to inflate the balloon to fill the entire vein, freezing tissue to -55 degrees Celsius. They can hit the tissue around the pulmonary artery in one shot, drastically decreasing the time of the procedure.
“We just put it against the blood vessel, and it delivers the cryo energy circumventially around it, instead of doing it point-by-point,” Dandamudi said.
Research has shown that about 70 percent of people who have the procedure never have atrial fibrillation again. Those who do suffer recurrence can get the cryoablation a second time, which bumps the overall success rate to 90 percent.
Dandamud suggested this would be an ideal treatment for Ehresman.
He went through the procedure in mid-October at Methodist Hospital. The procedure required that he stay overnight in the hospital, but he was able to go home the next day.
“I didn’t have any pain or anything after the procedure. I have four or five days where I had limited activities, but the main thing I couldn’t do was walk my dogs,” he said.
He suffered some minor chest pain, but it soon dissipated.
Total recovery took a few more weeks, but now months after the procedure, Ehresman feels as good as he had in years. He is back to going out on his daily walks and hikes with his dogs.
Once the weather gets warmer, he’s planning to get back to places such as McCormick’s Creek State Park and Brown County for hiking and camping.
“I’m busy planning now. I’m excited for this summer,” he said.
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Cryoablation
What is it? A method of correctly irregular and erratic heartbeats by freezing tissue inside the heart and veins leading to it.
What does it treat? The primary function is to correct atrial fibrillation, an arrhythmia caused by jumbled electrical signals causing the heart to beat unpredictably.
How does it work?
A balloon catheter filled with nitrous oxide is guided through the femoral artery from the groin to the pulmonary veins around the heart. The balloon is inflated, hitting all surfaces around the vein. The liquid nitrogen freezes the bits of tissue causing the atrial fibrillation and seals up the vein.
Why is it better than alternatives? Because it hits all sides of the vein at once, procedures can be done in two or three hours, compared to up to eight for previous ablations. In 70 percent of patients, it corrects atrial fibrillation on the first try. If a second cryoablation procedure is required, the success rate jumps to 90 percent of patients.
— Information from Medtronic.com and Dr. Gopi Dandamudi, an Indiana University Health cardiologist and the program director of the IU Health Atrial Fibrillation Center at IU Health Methodist Hospital
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