This interview is part of a special monthly section entitled “Cryotherapy Update,” which will be overseen by Section Editor Dr. Jose Nazari. Readers, keep posted for upcoming case reports, product highlights, and breaking research data.

Pilot Mike Curtin, post-procedure.

Mike Curtin faced a difficult crossroads in August of 2003 when he needed to schedule an ablation to treat his AVNRT. Curtin has been a pilot his whole life, and the risk of possibly having a pacemaker implanted would have ended his career. Through his diligent research on the internet, he came across a new procedure being offered: cryoablation. He became the first patient at Sherman Hospital in Illinois to have this procedure in which the temperature is brought down to -70 degrees Celsius and the tissue is permanently ablated. It is a low-risk option, and does not cause pain or discomfort to the patient during the freeze. Since his procedure, Curtin has been symptom-free and expects to fly again soon. Read more about his incredible story and about the doctor that helped him.

How did you get into flying? You said you began flying at age 13.
That’s correct. I wasn’t in the military or anything, I just always had a hankering for it. I live near an airport here in Concord, California, and ever since I was probably 11 years old, I would ride my bike there every day. When I learned to drive, I would drive there every day. I was just a real airport kid. I started taking lessons when I could afford them at age 13. I soloed near my 16th birthday, and I got my license when I was 18. I did that for several years until I started flying charter planes for smaller companies. I also worked for a regional airline for several years. For the last 18 years I have been flying for a private corporation.

Do you have any other family members that fly?
No, just me. No one in my family went into the military either. I wonder if it was because I grew up during the time of the Vietnam war. I graduated in 1974, but once the war ended and I didn’t have to go in, I just never found myself joining the military. So I never took the military route, I always just did private flying. I have done primarily a lot of rebuilding of airplanes and biplanes, racing planes, and taking them to air shows, that kind of thing.

Do you own a plane?
Not currently. I rent planes, but I also have to fly a lot of them when I rebuild them. However, I haven’t done that for about eight years or so. Some friends and I have aspirations about getting another biplane and building it up — we enjoy doing that. We have taught a lot of aerobatics as well. In the late 1970s, I was the only instructor around who had a lot of flying experience, so people would need me to fix their planes or teach them how to fly. I got to fly a lot of unusual antique planes during that time.

When did you first begin having symptoms, and what were they?
I remember, in retrospect, having symptoms of tachycardia when I was 14. I remember being on a tennis court, and although the episode was very short in duration and I remember thinking it was weird, that was sort of the end of it. It happened again a few times over the years, but never seemed to amount to much. I would always ask doctors about it, but they always told me not to worry about it. In addition, people told me that they had experiences like this sometimes, and so I was beginning to think that maybe this was a normal part of life.

It was when I turned 40, I was on a golf outing and my heart starting beating like it never had before. It would just go on and off like a trigger, and very quickly. Later I went to the doctor and had a echocardiogram, stress test, etc., and everyone told me that my heart was fantastic and everything was all clear. I accepted this — I just wanted to put it to rest. However, I began to feel less and less aerobically fit, and after a while, I wondered if this was just because I was getting older. So again I went to have another echo, blood work, a stress echo, and all of these other kinds of tests, but in the end I was told the same thing.

So what was the timeframe during all of this?
I would say this whole process took place over six years. I became less and less okay with my symptoms, and since doctors were telling me I was fine, I wasn’t sure what to do. I thought maybe I should begin medication, but it didn’t feel right to me, and it was a big step to move out of that arena. However, all of this was taken out of my hands on May 11, 2003, when I woke up at midnight with a sustained 200 bpm tachycardia. It lasted three and a half hours, which was only brought back to normal rhythm with adenosine in the ER. The nice thing, though, about this experience was that they were able to get an EKG of the tachycardia. The doctor at the ER told me to contact a cardiologist.

Unfortunately, I haven’t flown since that day. I had to take off work, since my appointment was six weeks away. That was a very difficult time for me, since I had nothing to do but think about the situation. I see what other people are going through now and I understand how dark of a time that can be. I had the curtains drawn for four months, doing nothing but researching and talking to people online. Although there are a lot of wonderful doctors out there, I really think you need to be your own advocate, especially in this field of medicine, and the internet opens a whole new avenue for you to do that. The message boards and chat groups online — that was particularly helpful. There are a lot of groups to join, depending on the ailment, that get together and talk to each other about their real experiences. I believe that a lot of the time, the doctors can learn a lot from something like this because it is one thing to have a doctor-patient relationship, but it is another thing when you are talking patient-to-patient, because different information is shared.

What was your diagnosis? Also, what were your treatment options?
I had spent a lot of time online, and when it was time to have my cardiologist consultation, I had already made my diagnosis — AVNRT — and had prescribed myself an ablation. Of course, I wasn’t looking forward to having the ablation — I was petrified! However, because of the risk of heart block and the resulting pacemaker and the possible risk with any surgical procedure, it was particularly important for me to have an ablation done. There is no flying for a pilot with a pacemaker — it would have ended my career.

I could have taken drugs for it, and if I had testing every year I would have been able to fly again, and the drugs probably would have worked. However, I didn’t want to take the drugs for a lot of reasons, primarily because of side effects, but they also seemed to be very ineffective as a general rule, and there was the possibility that they would become less effective over time or that the medications would have to be changed over and over again. I read online that people were having a lot of problems with the medicines. Even the ones that did control the tachycardia, there were a lot of unwanted symptoms and people weren’t liking them very much. So I decided on radiofrequency ablation (RF), because it seemed low risk and at the time was the only reasonable alternative. Also, once you recertify after an ablation, you never have to go back for any extra testing and you are just like everyone else.

What was the next step?
I made an appointment to have an RF ablation at a wonderful hospital here in the Bay area with a great record — John Muir Medical Center in Walnut Creek, California. Although I was petrified, I felt this was the best way to go. Unfortunately, that meant another three-month wait. Meanwhile, I was burning up all of my sick time. I knew that six months after the ablation there was a six-month wait between the ablation and recertification for pilots, so I knew that six months was built-in, no matter what. However, the longer it took, the more I was wondering how I was going to get by financially.

How were you referred to Dr. Jose Nazari?
It’s funny, because four days before my RF ablation, I was searching online and my wife said to me “you’ve searched so much already, shouldn’t you just leave it alone, meditate a bit, get right and just do it?” I said yes, but I couldn’t help it. As a pilot, and ever since I was a little kid, risk management was a big part of my life. So when I went in for my ep consultation, I had about 60 questions that I had filed from all the things I had read and researched. The doctor sat down with me for an hour and very patiently answered all of my questions. I was so impressed and very happy with the people I was working with. Anyway, four days before my procedure I was online and found a bunch of information about the cryoablation technique. As I read, I learned about its FDA approval. However, no one had talked about it or that it was available now or even that it was a procedure for avnrt. It was approved in april and there had never been a case for heart block with cyroablation. Talk about risk management — this sounded incredible! So here I am, completely committed and trying to focus myself four days before the ablation, and I am on the phone with Cyrocath. The woman who I talked to said she could introduce me to some doctors that had already started working on it — not many hospitals were using the technology in the United States at the time — and I was put in contact with dr. jose nazari, a Clinical Electrophysiologist from sherman hospital in Elgin, illinois and the Primary Investigator in the Clinical Trials for cryotherapy. Since Dr. Nazari had done a bunch of them, I decided to go with him.

However, at this point I had already burned up about four months of sick time and I was looking at another six months after the ablation. So I called up ted roberts, my Cryocath rep. Ted was extremely helpful and supportive during this time — he worked very hard to push things forward for me and to keep me informed. Anyway, they were just getting their cryotherapy system out at Sherman Hospital, which is just outside of Chicago. It was not even there yet, but it was coming. I was put in touch with Esther Weiss, RN, Manager of the Cardiac Arrhythmia Center at Sherman. Talk about an angel! She really helped fast-track the process. I called her that day, and two weeks afterwards, I was on the table. We have been friends ever since.

Wow! So what was the status of your other appointment?
This was a big issue for me. I felt horrible, because these people had treated me wonderfully. I called them up and told them that I didn’t want to try anything but cryo, at least for my first attempt. They said they had heard about it, but they didn’t have the cryotherapy equipment. Actually, they had been looking for a place to schedule in another patient who really needed a procedure done, and now they had my open spot for her. So it worked out, but still I felt bad about cancelling.

Describe your procedure.
I set it up and talked with her and they got the machine in, and they said “we’ve been making little snowballs today — everything looks good!” Then Dr. Nazari called me one evening and we spent a lot of time on the phone — he helped answer all of my questions. Actually, I was grilling him about cryotherapy. I told him that I knew quite a bit about this now, and said “if the catheter is a little thicker, is that alright?” He started laughing and explained that sometimes you may have different pairs of shoes, but you can still walk in all of your shoes! I ended up bringing everyone bottles of California wine, but said “you are not getting this until I get out of this room” — you know, to have some incentive! I had my cryoablation on August 25, 2003. I am now coming up on my three-month anniversary.

How do you feel now?
I am now 47, but I feel like I am 19 years old. My whole family and I now hike, golf, and go on bike rides every weekend. I feel like there is nothing I can’t do. I feel better aerobically than I have in 20 years. I didn’t even realize some of the symptoms I was having before.

Will you be able to fly again?
I have three months and one week from now, and hopefully I will be recertified by late february 2004. I am living a miracle. There were things that were happening before that I didn’t even know about that are now gone. It is an amazing thing. I wake up every day and feel very lucky.

What are your plans now?
I have spent a lot of time online to help people look at what is going on. There are a lot of people out there and it is amazing to me how people are reluctant to change and how things can happen so slowly. I want to help further that change, so that people can at least have their first attempt at ablation available with cryo and know the risk management involved. The ring catheters come out next year that I am sure are going to be great.

When I talk to people who have had the rf ablation, almost without exception they talked about an uncomfortability in the first six months. There was a lot of thrombosis with the rf lesion, and they said that sometimes they actually felt worse in the first three months! I have not had that — it has been smooth as silk, and I feel great.

What is your advice to other patients dealing with this? What is the most important thing they should know?
I think the most important thing is that you have to get online and start talking to people, hear other people's experiences, and figure out what you’d like to do next. Then of course you need to get a very good specialist like a cardiologist. Ideally you’ll have to be patient enough to get a strip of your tachycardia and a verification of the type of arrhythmia you have. Next, I would recommend finding a place that offers cryoablation and giving it a shot. Also, learn if your condition is the type of thing that cryo can fix. Going in with cryo first seems to me to be automatic.

Dr. Nazari and I talked before my procedure, and he asked if the cryo didn’t stop the arrhythmia, would I like him to continue and do the rf ablation instead, if it was safe. I said yes. I think it is so important to go with cryo first, though, since it is so much safer. Then you can decide later if you want rf or not — that is going to be an individual decision.

There are a couple of things that I think all ep doctors should know, because there are people like me and there are going to be more who are going to be pushing for cryo due to its safety aspects. It is not that rf isn’t going to be here forever or at least a long time, because there certainly is an application for it. However, you’ve got to have cryo in the arsenal as well. I am creating a website — and I am having other people link their websites to Cryocath. There are people out there that will not do an ablation because of the possibility of heart block. So they are having horrendously impacted lives. When I talk to people online — I have talked to many since my ablation — I have them email me directly and also give them my phone number because I always want to talk about it! I have had people from all over America, Europe and Canada calling me and asking me about my procedure. There is really very little reason not to do it, if your life is reasonably impacted by an arrhythmia or whether the impact is physical or mental, both are very serious, because once the fear is in there, it really limits people in their lives.

I agree. It is especially awful considering the length of time most people have to deal with it before they get treatment.
A lot of times people go in for a diagnosis and are told they are having a panic attack — only later do they learn that it is tachycardia. It is a very uncomfortable thing to experience, and if I ever had to have the adenosine again, that would not be a very good thing.

To look at it from a business or ep standpoint, if ep doctors had this in their arsenal they would double their potential clients, lower their litigation aspects drastically, and since the machines are only about $50K, you are helping people lower their risk, and you are helping twice as many people or more. I think cryo is going to be the gold standard in a few years, and I would like to see more people bringing it in and the technology getting to the people. I am hoping it’s not going to take too long.

Is there anything you would like to add?
I think the patient population will probably push this forward, more than the doctors, since doctors tend to keep to what they are used to doing, are successful at it, the risk has been low, and it is hard to change. However, the more the patients demand it, the more I think doctors will change. I understand how the transition might be tough — if I were to compare it to learning to fly new airplanes, well, it took a lot of training to learn the new technology, but once you begin, it is hard to go back. Generally, a transition is hard to do, but worth it in the end.

In addition, I was talking to Dr. Nazari after the procedure, and he noted that the transition to cryo was really quite easy and natural, and there is not as much stress. For example, when Dr. Nazari knocked my ablation out — and I was awake for this — I remember Dr. Nazari said “‘bye-bye” and started dancing around the lab! It seems a lot better than worrying about heart blocking someone. Dr. Nazari is just a phenomenal human being and a great doctor. Him and Esther — what a team they are, and I really appreciate them. I can’t tell you how supportive my family has also been.

We have got to get the word out, though, because there are so many people out there who call and email me every day and say “I hear you got help” or “I want help” or “I am tired of this.” In my opinion, one unnecessary heart block is way too many. If just one patient can learn from my experience and feel what I am feeling as a result of what I did, I would feel very blessed.