Double ablation

[Tbernst]

I have atrial fibrillation and atrial flutter and they are not responsive to beta blockers or sodium channel blockers. My EP has suggested a double ablation - RF for flutter and cryo for afib. Has anyone tried this? It is my first ablation.

[Buffafly]

I had RF ablation for Flutter and PAF at the same time. Saved having GA twice and has been very successful, not 100% but I'm happy.

[Tbernst in reply to Buffafly]

Thank you for your comment. It's great to be reassured.

Did they use RF for the PAF or crioablation? By not 100% do you mean you still have occasion Afib or flutter? How long has it been?

[Buffafly in reply to Tbernst]

I had RF for both. I had had PAF for many years, at least 16, and my EP was concerned I was about to go into Persistent. Reading the report of the procedure he did a lot of work, not just the PVI. I have had two short episodes that I know of since I had the ablation a year ago, both when I had a bowel infection. I also get little runs of 'wobbles' - ectopics mixed with tachycardia and little pauses which only last a minute or two. I feel much better than before, partly because the medication I was taking caused side effects I'm very glad to be rid of! I'm not allowed to take the medication I was on before because of dangerous side effects so if it hadn't worked a pacemaker was the next option.

Good luck with your procedure, as Bob says I have not heard of a mixed treatment before and it will be interesting to get feedback from your experience.

[Tbernst in reply to Buffafly]

My PAF was first diagnosed around 2 years ago but I think it must have started before that. The first cardiologist thought it was the result of HCM but others are not do certain. He prescribed bisprolol which worked for a while. I'm worried about going into persistent as just minor efforts send me into PAF and when I exercise I go into flutter. I tried flecainide but it just made things worse. I have to wait until February for a slot but I guess Eliquis will keep me safe. From what you say I would guess you still take an anticoagulant. As for the mixed ablation I have read that the risks of heart block are lower with cryo as it is reversable during the operation whereas RF on the right atrium for flutter is less problematic.

[SRMGrandma Volunteer]

I know of a lot of people who have had AF and flutter both ablated at once, but I've not heard of using both techniques during the same procedure. I'm also interested to hear if others are more familiar with that. Good luck to you! I had both AF and flutter taken care of in my ablation with excellent results.

[BobD Volunteer]

From a pure mechanics perspective it is easier to use RF for both. The reason is that in order to access the left atrium they arrive at the heart in the right. They then punch a small hole in the septum to move into the left and do the ablating there. It is usual when doing both to then ablated for flutter on the way out I understand. Cryo ablation is wonderful for pure pulmonary vein isolation but has limitations where there are complex signals firing off in other areas which require RF ablation.

Many EPs feel that very early intervention with cryo ablation before AF has had too long to become established stands the best chance of success and can be done in as little as an hour or so. More established AF will usually need RF ablation of the extra pathways but this is sometimes done as a second ablation.

Flutter can't be done with cryo so he is obviously considering doing flutter first with an RF catheter and then removing the equipment and starting again with a cryo balloon catheter. Not heard of this before but technically quite possible.

[Tbernst in reply to BobD]

Thanks for the information. It might be a question of local practice as I am having the operation done in France. All patients spend 24 hours in intensive care after ablations which does not seem to be the case everywhere. It seems

[BobD Volunteer in reply to Tbernst]

Sounds quiet sensible to me. I had mine at 8 am (about 4 1/2 hours) and went home 3 pm next day, All cardiac wards tend to be high dependency which is the current jargon for intensive care.

[Buffafly in reply to Tbernst]

😂 I wish!