Cryoablation or RF Catheter Ablation

[NJ47]

Following my 3rd DC Cardioversion on Monday, it's now all systems go to get this thing well and truly fixed. I've been in and out of AF so many times since last September it's starting to get scary. From September to November I was in and out of AF every 2-3 weeks. Since my first DC CV I've managed to stay in sinus for just over 6 weeks each time.

On talking to my Cardiologists secretary today, he is referring me to a very highly respected EP at Glenfield Hospital. I already know they'll be using 3D imaging, but I'm told they don't do cryoablation.

What's the difference between cryoablation and the more traditional method of ablating?

Does Cryoablation give a higher success rate? Are there more pros and cons for one method to the other?

Any comments most welcome. I've already made the decision to have an ablation and know I may require more than one procedure. It would just help to understand the difference between the two methods.

Thanks in advance,

Nigel

[BobD Volunteer]

OK NIgel how long have you got? The traditional catheter ablation technique uses radio frequency to heat the tip of the catheter to create a small burn, This burn then produces a scar which can't pass electrical current , so in theory the rogues are stopped. It take a lot of these small spots to form a line around each of the four pulmonary veins where these impulses are thought to come from. The EP can also draw lines in other areas of the atrium if he suspects that they are firing off as well.

Cryo ablation uses a small balloon which is fed into the entrance of the pulmonary veins and then a cold gas is pumped in which causes a freeze burn. If the only places firing off are the four PVs then cryo can be more successful but if other areas are affected you may then need a second RF ablation to tidy up. It all depends on the extent of the electrical chaos. Many centres only do cryo as it is relatively quick and easier to do and if your AF is very simple then it may work for you.

There are other methods which I won't go into here but there is a new booklet either out or coming out on the main AF-A website explaining all the facets of ablation .

Hope that helps.

Bob

[NJ47 in reply to BobD]

Thanks for this, Bob. I was only saying to my partner I bet I get an answer from your good self. SO very grateful. Glenfield don't do Cryo which is why I was asking. I don't suppose you know the difference in success rates do you? If we're talking a difference of 5% I'm happy to go with RF, but if it's closer to 25-30% then should I look closer at cryo? The stats would be really useful. I'm guessing also that when my case is investigated further if my EP thought a cryo procedure would be better for me, do you think they would refer me on?

All I know at this stage, assuming I'm offered an ablation I am 100% taking it.

Anyway, once again, Bob, thank you SO much for your support, wisdom and knowledge

Nigel

[BobD Volunteer in reply to NJ47]

Nigel I think the point I am trying to make is that there is no right or wrong answer. Cryo-ablation can be successful if your AF is simple which I think is why it is tried often as a first line attack but RF is more flexible although more difficult to obtain a full coverage due to the need for multiple small burns. Cryo being easier to perform is often faster so more people could be treated but does that actually make it better? I can't answer that. You could have four perfect burns with cryo and still have AF if there are secondary areas firing off. There may also be physiological problems in the way the PVs enter the atrium which render cryo unsuitable. Until they actually get to the coal face they can't really tell even with complex CT scans. Success rates are always no better than guidelines and one must accept that ablation is part of an ongoing treatment and may well need to be repeated. As you will know I am a great advocate of ablation having had three and knowing that success rates are improving all the time.

[NJ47 in reply to BobD]

Thanks for this, Bob. I guess I was a little concerned as I'm told my specialists don't do cryo so I was questioning if what I needed wasn't available at my preferred hospital.

I guess it's another case of stop worrying and leave it to the experts. Having the additional knowledge you've just shared, Bob, really helps.

Thank you

[jennydog]

Bob's advice is excellent.

Cryo ablation would not have worked on me because I have 2 conjoined pulmanory veins which enter the heart as a large hole. The cryo balloon would be too small for it. I understand that up to 25% of people also have this type of irregular plumbing. Cryo ablation is quicker and therefore easier ( for them? )

Your Centre of Excellence is offering you RF ablation for a reason.

[flyfisher]

You should be thinking of 3 methods, cryo balloon, laser balloon and spot rf ablation.

Which to use would largely depend on what they are trying to ablate.

For example, if you had a single point of leaking electrical activity in the atria, then a rf spot ablation would be suitable.

If you were having a pulmonary vein isolation due to spurious electrical firing from the attached veins, then you would have a choice of all 3 methods. The old method was a circle of linked spot ablations to form a ring around the vein. The newer methods seem to be a balloon ablation, with either a laser or cryo inside the balloon, which forms a continuous scar around the vein.

The newer methods of cryo or laser seem to be both quicker and more successful than the old methods, resulting in less follow ups being required.

I would be happy with either laser or cryo and would assume your e/p has the laser balloon equipment.

I read a post recently which observed markedly improved a/f free rates after 2 years for patients who added personal health improvements and a low GI diet to their recovery plan.

[NJ47 in reply to flyfisher]

Thanks for this, Flyfisher. I haven't even asked them about laser. I'm sure I'll find out all these answers in due course. The GI diet is worth knowing about too, so again, thank you.