RF or CRYO ablation? What are your doctors ... - AF Association

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RF or CRYO ablation? What are your doctors saying


Hello everyone. Big thanks to everyone for kind and helpful replies recently that brightened my day. Here over the pond it is not necessary to have any failed drug treatment before ablation. My EP in Florida can not say which ablation is "better". He does RF only - success rate 60% which is scary to me.

I see that New York major hospitals can do both.

Could you put more light on this please. Which one should I choose?

Radio frequency (RF) or Cryoablations. Thank you family.

13 Replies

Hi Adriatico, You can certainly get a good result with either. Generally speaking, the RF tends to have a little more long lasting results, though the Cryo is better in certain situations. The bottom line is to go with an EP who is highly skilled and highly experienced at whichever. I've read a lot of analyses in the Journal of Cardiac Electrophysiology and it seems to come down to experience, experience, experience! Good luck with whatever you choose.

adriatico in reply to SRMGrandma

You are so right. Experience is everything. You don't want to end up in hands of some beginner.


OK it isn't a simple yes no or even maybe.

Cryo is best .oh no RF is best. Really it depends on what your impulses are doing. I will try to explain.

Cryo ablation uses a small balloon on the end of the catheter which is inserted into the entrances of the four pulmonary veins. It is from these that many rogue signals are thought to come. A very cold gas is pumped in which causes a freeze burn of the area and subsequent scaring. It is these scars which block the rogue electrical signals. Being round like the veins, the balloons give good coverage and a fairly even scar.

RF ablation uses a catheter with a tip which can be heated by radio frequency energy (RF) and makes dot scars. The EP then has to make a series of dots around the area to isolate it.

OK you may well think that cryo is therefore best and in some cases you would be right. The scar is generally more even and likely to be more successful BUT only if the four PVs are the only source of the rogue impulses. Many people who are treated by cryo ablation have some improvement only to find breakthrough events some months later. This usually means that new pathways have started to form (or previously existed) which may then need to be ablated by RF since a balloon can't do the job out in the main atrium.

SO to round up, if you have simple AF where only the four PVs are at fault then cryo will be faster and more efficient with a faster recovery (shorter procedure =less trauma) but this may not be all you ever need to have done. RF is more difficult from the EPs point of view and may still need top up(s) at a later date due maybe to small missed areas.

Nothing is guaranteed!

I do hope that helps but for a more detailed explanation there is a great fact sheet/booklet available for down load from AF Association main website under publications.

Welcome by the way


adriatico in reply to BobD

Thank you Bob. You are always there to provide helpful answers and lift someone's spirit. I am new here but I think that everyone agrees that you are very SPECIAL. I will be free to also thank you in the name of others for your regular help.

I guess I will leave the decision to the EP.

BobDVolunteer in reply to adriatico

Aw don't embawass me.

I was recommended to go for cryo procedure initially, and haven't had any AF since (2 months later). But the EP did say that I shouldn't expect it to be the only procedure- if I am lucky, it will be. I may well need RF later.

adriatico in reply to Andyu80

Looks like that you are lucky. I wish you that the same luck continues to serve you.

My husband's EP in SW Florida appears do do mostly cryoablation with excellent results. My husband is 84 and came through his very well. Perhaps you should get a second opinion. Is your EP qualified to do cryoablation? Perhaps he does not have the training for it.

adriatico in reply to cherylbyrd

Thank you for your valuable info. When did your husband have the procedure? I am in SE Florida and I think that I need second opinion and EP with good experience. I am guessing now but I believe that you are in Naples. Could you help me with some more details.

Again, thank you for writing

Adriatico......just had my cryo a month ago at Northwestern Cardiology Bluhm Center in Chicago a month ago. They do more cyro supposedly they get better results. They do 400 ablations a year.

I was on beta blockers for 3months and we decided cyro would be best for me. I am a runner and have run 2miles already :) I still am experiencing rapid pulse when running . I am on Eliquis and no other meds. Will go back at 3month checkup and then wear a hrt monitor for awhile. I also had to get a TEE day before the ablation.

All in all hoping this works....patience is certainly a virtue!!

adriatico in reply to Geegee26

Running after one month - good for you Geegee and thank you for writing. You are doing great. Be careful when running though - you don't want to slip, fall and get injured while on Eliquis. Any idea how long will you stay on Eliquis? My EP says 6 months on blood thinners and that some doctors even suggest 1 year?!!!!! I've never heard of that and don't see anybody mentioning that time on this blog. I only loose confidence in my EP who spends more time joking during my visits.

I wish you all the best at the next checkup and many many more miles running

PeterWh in reply to adriatico

You must have missed that because some actually say you should be on them for life!!!!

They are NOT blood thinners - they are anticoagulants. Why not slipping and falling? You may get a cut and bleeding for some seconds longer than if not on anticoagulants or get some additional bruising. Very rare indeed to have major issues.

adriatico in reply to PeterWh

Thank you for enlightening me Peter. There is always something to learn here

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