GA or Sedation? Cryoballoon Ablation or RF Ablation?

[Hilarie]

I had my first ablation under GA. The procedure took 7 hours and my lung was punctured. I got a urinary tract infection probably through being catheterised after the procedure and felt groggy for at least 3 weeks afterwards. But, my PAF stopped for about 7 months and I am now on the waiting list for a second ablation. I am hoping to see my EP to discuss whether I can have the second ablation under sedation and also whether it would be better to have a cryoballoon ablation rather than a RF ablation.

Has anyone had a cryoballoon ablation or an ablation under sedation? If so can they give me any advice or info I should discuss with my EP?

[BobD Volunteer]

I think you need to understand that cryo balloon ablation uses a balloon to create a freeze burn to produce a ring around the entrance to each of the four pulmonary veins. That is it. Now that is fine if you have paroxysmal AF and all your rogue impulses are coming from the veins but if there are other sites firing off then you need extra burns which will have to be done with RF. SO maybe a combination of both or RF only.

Now GA or sedation. Personally I had no choice with my three-- all GA because that is what my EP does and I was very happy not to have to be there when he did it if you see what I mean. BUT many people find that the initial recovery is easier after just sedation. The heart wont recover any quicker. That takes three to six months whatever but other factors can be easier without a full GA. Some EPs won't give you a choice and of course laser ablation is GA only for safety reasons as they can't have you move just as they are about to fire the laser. Oops missed! Bugger! lol Laser balloon ablation is still new and not available everywhere.

Sorry about your UTI. I had a catheter for four weeks after prostatectomy so know all about them. Not heard of anybody having catheter following ablation before.

Anyway some info for you to discuss with your EP. Hope it helps.

Bob

[Hidden]

Hi Hilarie

I've had GA and not much to say about that really, you go to sleep, you wake up. Afterwards I felt groggy but simply brilliant by the time I got home. That lasted for a few days. Must have been the drugs? They didn't ablate though because my AF had disappeared and they couldn't even stimulate it with drugs.

Also had an ablation under sedation 8 years ago. I don't know what they gave me but I felt extremely relaxed and time flew by. I watched them do the procedure on screen. I couldn't feel anything except when they started ablating I got some pain and I remember groaning, hearing the word "morphine", and that was that, woke up in bed feeling fine. I had a groin infection first time and was kept in for another 24 hours till they were sure it was OK.

That was RF. Never had cryo.

Given the choice GA/sedation, (which I wasn't) I'm not sure which I'd go for, probably sedation because it was interesting.

Koll

[avma in reply to Hidden]

Hey,

Found your story very interesting.

Could they trigger you arrhythmia while you were so relaxed from the sedation? Did they do it with the catheter or was it necessary to use adrenaline?

[flyfisher]

Hi, I had a laser balloon ablation under GA to isolate the left side pulmonary veins, which went well. Subsequently I had a second op which was a spot ablation for avnrt, under mild sedation, which again went well. It only took 50 minutes and was no more onerous than a dental proceedure.

As bob commented, it all depends upon what they are trying to ablate. If it is a repeat pulmonary vein ablation, then the newer methods of balloon ablation, either by laser or cryo, seem to be more successful.

Good luck

phil

[MarkS]

Hi Hilarie,

It sounds as though your first ablation wasn't ideal. How experienced was your EP? Have you considered a different EP?

I had sedation and I think it's a lot better for the patient than a GA. Being under GA for 7 hours - that's a very long time and I'm not surprised you felt bad afterwards.

I also had combined RF & cryo. As Bob says, cryo's good for isolating the pulmonary veins but not much else. Why did your ablation take 7 hours? Was there a problem outside the PVs that the EP had to fix? If so then RF needs to be used for that. If it was just the PVs and there's been a breakthrough due to incomplete scarring then cryo might be an answer.

Mark

[Therealsue]

I had my RF ablation done under sedation. Didn't feel a thing - the worst bit was the local anaesthetic into the groin before they put the catheters in as they hadn't done the sedation by then. Once they started with the drugs, the next thing I remember was 5 hours later having all the electrodes removed. I was a bit groggy for a couple of days, but otherwise fine. I'd go with sedation again if I ever have to have another one.

[Sharon1234567]

Hi I had a cryo ablation under sedation 3 weeks ago it took 2 hours. There was very little discomfort and my EP kept me fully informed of what was happening throughout the procedure. My recovery was very quick. 48 hours later I felt very well no discomfort no breathlessness and so far no AF even though it is too soon to know if it has been successful as with my PAF I can go months without a a full blown AF attack needing chemical cardioversion. I hope all goes well whichever method you go with.

[iris1205]

Generally the choice of cryo is an operator decision, if I didn't like their choice I would choose a different EP rather than encourage the doctor to use a method that is not his habitual method! I've had 4 RF PVI ablations with a few spot "welds" in foyers which were firing randomly. All were done with light sedation and I am most grateful for being semi-awake. Recovery was very quick and I had a complication during the second ablation and was able to voice my situation which changed the outcome completely.

I hope you get some relief soon, if you like your doctor allow them their choices, I would just ask all the questions as to why, so I could feel comfortable with their choice!

[Hilarie]

Thank you all so very much for your really helpful replies. They are much appreciated and have given me a lot to think about - what a minefield the whole thing is - but it is so good to know that one is not alone in the up and down crazy world of AF!

[SuzieA]

I had a cryo with sedation 4 weeks ago and would not hesitate to go down that route again if necessary, good luck x

[Rbyy]

Hi. I just had a cryoablation Jan 9. Under sedation took just over two hours. Fairly simple but I now after two months still have alot of chest pain. Find a high volumn center. My doc and hospital does 250 ablations a year. Other than my chest pain no big issues. Seeing card tomorrow. Best of luck!