CRAIG T. KOJIMA / CKOJIMA@STARBULLETIN.COM Dr. Hingson Chun, right, who performs cardiac cryoablation treatments for people with irregular heartbeats, works with Dr. George Van Hare, far left, a pediatric cardiologist at Stanford University. They are shown in an operating room, waiting for the cold-tip catheter in a patient to drop to freezing. Registered nurse Lynn Benny monitors the temperature.

Heart pounding

Cryoablation helps tame a Kauai woman's too-quick ticker by using cold temperatures instead of applying heat

A young Kauai woman became the first Hawaii patient to undergo a procedure using freezing temperatures instead of heat to treat her rapidly beating heart.

Electrophysiologist Hingson Chun of the Straub Heart Center performed the "cryoablation" technique on July 23 with Dr. George Van Hare, Stanford University pediatric cardiologist. The doctors discussed the successful surgery with the Star-Bulletin this month.

The patient was Lynsay Tsukamoto, 19, who had suffered from a rapid heartbeat since she was a junior at Kapaa High School. "It felt like my heart was in my throat," she said.

Medication, emergency hospital visits and two conventional ablation procedures using heat to destroy tissue interfering with her heart's normal electrical impulses didn't fix it.

Cryoablation isn't appropriate for every patient, Chun said, but after nearly seven months, Tsukamoto's irregular heartbeat appears to be cured.

COURTESY PHOTO Lynsay Tsukamoto of Kauai successfully underwent cryoblation surgery last year, a technique that used freezing temperatures to treat her rapidly beating heart.

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CRAIG T. KOJIMA / CKOJIMA@STARBULLETIN.COM Dr. George Van Hare, a Stanford University pediatric cardiologist, reviews various readouts of a young patient's heart. This information will help him decide which area of the heart to freeze during a cryoablation procedure at Straub Hospital.

Lynsay Tsukamoto, 19, of Kauai was a high school junior when her heart began "pumping really hard."

She said she got to class one day and "felt like my heart was in my throat ... I had a hard time breathing."

That was the beginning of a series of trips to the emergency room for medicine and procedures to treat her rapidly beating heart.

Her last procedure was a first for Hawaii -- cardiac cryoablation, involving freezing tissue or pathways that interfere with the heart's normal electrical signals.

After going to the emergency room three times from 2005 to 2006, Tsukamoto said, her cardiologist on Kauai referred her to Dr. Hingson Chun, electrophysiologist at the Straub Clinic and Hospital Heart Center.

In July 2006, Chun performed a conventional ablation on the teenager. A common treatment for certain types of abnormal heartbeats, ablation involves destruction of cardiac tissue or electrical pathways that interfere with normal distribution of the heart's electrical impulses.

Chun used heat-based ablation -- inserting a catheter into the heart to destroy a small part of heart tissue with heat and stop the abnormal electrical impulse.

"Then it happened again," Tsukamoto said. She was back in the ER in August 2006 and had another heat-based cardiac ablation two months later.

After three more emergency visits to the hospital between December and July 2007, Tsukamoto became the first patient to have cardiac cryoablation in Hawaii.

Chun performed the surgery with Dr. George Van Hare, director of the Pediatric Arrhythmia Center at Stanford University and the University of California-San Francisco.

Van Hare comes to Hawaii several times a year to treat children. He also has been coming here with other mainland experts to treat kids with life-threatening disorders during annual "Heart Weeks" sponsored by Straub and Kapiolani Medical Center for Women and Children.

He has used cryoablation for a long time for children with cardiac problems and asked Chun about a year ago whether he would consider using the method, Chun said.

Van Hare explained in an e-mail that cryoablation "is a big advance for children in particular" because it can avoid "heart block," a major complication requiring placement of a pacemaker.

"For the conditions in which cryo is being used, the risk of heart block is about 2 percent," Van Hare said. "Avoiding the risk is particularly important in children as the need for lifelong pacing will obviously be more long-term than in adults."

Chun said he analyzed the technology and "it seems to be a safer, more predictable way to alter conduction tissue." So he began using cryoablation in July, last year.

Tsukamoto, his first patient, had a very rapid heart rate, about 200 beats a minute, causing tremors and shortness of breath, he said. "It's not fatal but very disabling.

"We were very reluctant to be aggressive because we didn't want to end up giving her a pacemaker. We ablated her twice (with heat) and she still had complications."

However, she did well after the freezing technique, he said. "As far as we know, she's cured."

He said cryoablation basically is "a new way to do an old established technique." The distinction is in the radio frequency, he said. "Instead of heating tissue, you actually freeze it."

An advantage is that the frozen tissue can be rewarmed and restored to normal electrical function if it isn't responsible for the abnormal heart rhythm, he said.

"Once you cook something, it's irreversible. If you freeze it, you can thaw it and it's good as new."

Chun said Hawaii "is indebted" to doctors like Van Hare who come here and share their expertise. "I can't stress enough what a tremendous benefit it is to patients and families to have it (cardiac cryoablation) done in Hawaii" instead of having to go to the mainland, he said.

Tsukamoto, studying business technology at Kauai Community College, said she hasn't had any cardiac problems since the last surgery. "I feel better. I'm not afraid now."