Cryoballon Ablation

[Bahman]

Hi to all !! I have been following Juggsy's posting on the forum . Very interested in your thought process . I too have asymptomatic PAF . Have just seen my EP an excellent man with lot of time for me Dr Simon Sporton I highly recommend him. He has many years of experience and research in the field of ablation . He is recommending cryoBallon ablation, and has suggested I should spent some time thinking about it . His success rate is 70-85% with 90-95% on round two.

Like Juggsy I have been in touch with Dr Sabine Ernst , she has asked for my medical history which I have supplied ,and am now waiting for her to come back to me.

Not sure which way to jump cryoBallon or Sabine's RF ablation with the use of new nuclear scan . I am a little confused why Dr Ernst is using RF ablation as oppose to cryoBallon since the latter has shown to give higher success rate ? I do appreciate the the new scan give far better mapping of the nerve endings . Any thoughts will be appreciated .

[Hidden]

Bahman, I think I am correct in saying that cryoablation only targets the pulmonary veins whereas RF ablation is capable of targeting other areas of the heart as well which may be responsible for the arrhythmia

[PeterWh in reply to Hidden]

Yes I agree.

[BobD Volunteer]

OK Bahman, you need to understand the differences and for that you can't beat the AF Association booklet on ablation but here is a short form instant access easy guide.

If the four pulmonary veins are the only source of the rogue impulses then cryo balloon ablation is quick and has a good chance of stopping them. It does have limitations in that if other areas are firing off they can do nothing. Cryo is only effective for simple AF where only those veins are the source. It is a different horses for courses and you can't compare apples to pears so neither is better than the other.

RF uses a catheter with a tip that can be heated to produce a heat burn but only over a very small area. A series of burns needs to be made to isolate any vein or other area which takes longer.

What I have read about Dr Ernst's new therapy is that in addition to the usual areas to be ablated she is targeting some of the sympathetic nerve system of the heart which obviously requires the precision which only RF can give.

Hope that helps.

Bob

[Bahman in reply to BobD]

Hi BobD , Thank you for that , be assured I was not beating any one , especially AFA book as I have not received one or read it as yet . Clearly I need to do a little more homework on this subject . Once again thank you all for your comments .

[BobD Volunteer in reply to Bahman]

You can read or down load direct from the website. Never occurred to me you were beating anyone. Just trying to explain why cryo has limitations for this procedure. Because it is generally faster and easier for both patient and team, with less X ray exposure etc cryo is often tried as a first treatment plus they can do more in a day.

For many people with simple PV induced impulses it is fine but you really can't say it is more successful. True the balloon tends to create a more consistent scar within the entrance to the PV than a series of dots but because it can't be used anywhere else and because not everybody has nice concentric PVs it has limitations as of course does RF. Many people who have cryo subsequently need a second RF ablation to hoover up any additional areas.

Bottom line is it is all a bit vague anyway but still very new science and we are getting better results year on year as experience is gained.

[pottypete1]

All my ablations have been the RF variety. On the most recent occasion, in addition to areas around my Pulmonary Veins they ablated the roof of the Left Atrium and on the way out dealt with Atrial Flutter in my Right Atrium.

Pete

[OLdCroc in reply to pottypete1]

Pete could you describe any symptoms you got from atrial flutter? Thanks. Geoff

[pottypete1 in reply to OLdCroc]

When I was lined up for my first AF ablation they found on the ECG that after being in AF for a couple of days I developed Atrial Flutter spasmodically. So they decided to do an Atrial Flutter ablation the first time instead of an AF ablation.

Trouble was that after that I have now had 4 AF ablations too.

3 weeks ago I had no idea that this was happening as well as the Atrial Fibrillation.

So in answer to your question I personally was not aware of it I was just having all the usual symptoms of AF.

It was a bit of surprise when I woke up from the AF procedure to find out that I had ended up with a bonus BOGOF. (Buy one get one free).

Pete

[Gracey23 in reply to OLdCroc]

Geoff, I had atrial flutter along with AFib. I had the flutter ablated a couple of years ago and am awaiting Cryoablation for the AFib next month. I must have developed the flutter after having AFib but no one is sure which came first. I can only tell you that when in flutter my heart didn't beat iirregulary as with AFib instead it was steady and very fast. It felt more like I had run a Marathon . i hope this helps, Gracey

[CDreamer]

Many people, me included, do not have 4 pulmonary veins - I have 3,1 of which is huge, according to my EP - haven't eyeballed it myself you understand. This makes it impossible to use cryoablation as the whole idea is to cover the entrance of the vein with the balloon in one go.

[jennydog in reply to CDreamer]

My plumbing is the same as CDreamer's and I understand that 25% of people are similarly equipped.

[Rellim296 in reply to jennydog]

Hearts vary surprisingly often and as jennydog says around one in four does not have conventional plumbing. Apparently lots have only one pulmonary vein on the left side, very few have just one on the right side. Some go the other way and have 5 pulmonary veins.

[Gracey23 in reply to Rellim296]

When the EP is preparing to do a Cryoablation do they know ahead of time how many veins you have according to the CT Scan they do ahead of time? I'm scheduled next month and would be very sad to find out after being put to sleep, etc to find out the procedure can't be done. Gracey

[Rellim296 in reply to Gracey23]

I don't know the answer to this, Gracey. I've never had a CT scan. I've had two echocardiograms and I imagine these might show up pulmonary veins but perhaps not. I had a 3D image of my heart created during my third ablation - lots of very cold stickers applied, left right and centre. Ask your EP what the situation is. I haven't heard of anyone not having an ablation just because they have an unsuitable heart construction. Three quarters of us have four veins, as normal. I've two on the right and one on the left, but my second ablation was by laser with balloon and camera and it improved my heart enormously.

I hope it will go well for you. There are so many things to worry about and most people say afterwards that they didn't need to worry about most of them. I've said before that the waiting is the worst bit.

[jennydog in reply to Gracey23]

Gracey23 I'm not sure. I had had an echocardiogram and was scheduled to have cryoablation but had a change of EP due to an emergency in the department. It turned out that I was SO lucky as the new EP opted to do RF on me. Afterwards he said " Given your history we were surprised at what we found." I apparently have fibrosis of the left atrium which must have been caused by radiotherapy to my left shoulder.

[Hidden]

Hello Bahman. I have just seen your post regarding the ganglionated plexus ablation for atrial fibrillation being trialled by Dr Sabine Ernst . I have today had the paper work through explaining the procedure and also the consent form. I put my name forward for Dr Ernst trials a year ago . I am looked after by the Royal Brompton Hospital and she is now my EP. I have asymptomatic PAF which lately has upped its game a notch and in some ways is behaving differently to when it first started and so I am going to go ahead with this trial before it gets any worse .

Dr Ernst believes that ablating the nerve endings that come from the sympathetic nervous system into the heart would improve the outcome of catheter ablation. For many people they have to return for a second and third ablation and some go on to have even more this trial is about eliminating that need.

I must admit reading the paper work and what it entails is not for the faint hearted

but, I have already been contacted today to undergo a nuclear scan the appointment has been made and I am determined to keep it.

I do not want to live my life eventually being controlled by this condition if I leave it to get any worse. I do not want to go on a toxic gosh of medication. I want my health back to what it once was. The decision for most I am sure will be a hard one whether to participate in these trials but, Dr Ernst is a very clever and committed Cardiologist EP she does not just give standard care which is all that is required in the NHS she gives gold standard care to all her patients that is known for.

I hope that what ever decision you make and decide to go for works so that you can be free once again without the aggravation of AF in your life

Good Luck

Barbara