Cryoablation vs radiofrequency ablation

[Aqua_1]

Hello everyone. I have seen two EP's with a view to getting an ablation. One has advised that he will use the cryoablation technique whilst the other has mentioned radiofrequency. Whilst i know whats involved in both techniques i am not sure which one is better/safer than the other? FYI i have paroxysmal AF and diagnosed earlier this year. Thanks in advance for your replies.

[Hidden]

Hello Aqua, if your heart is in good general condition, many EP’s prefer to carry out a cryoablation first because it is a relatively quick procedure for dealing with the tissue around the pulmonary veins. This tends to be the main problem area for AF and the procedure is generally quicker because it is normally performed under sedation rather than a GA and the expanding balloon will treat more surface area. Because a cryoablation can sometimes miss rogue areas, it is occasionally necessary to have a follow up RF ablation which tends to be more precise and I am a classic example. I am due to have a RF ablation at the end of August to “touch up” the bits that might have been missed back in 2016. Both methods carry some risk, but I understand that a cryoablation is deemed to be the safest which is another reason why they often do it first.

[Aqua_1 in reply to Hidden]

Thanks so much Flapjack. Interestingly the EP told me that CRYO would be done under GA and also I would no need to take anticoagulants before the procedure but would need to do so for 6 weeks after. The EP who recommended the RF has told me that I would need to take anticoagulants both before and after? It's all very confusing.

[IanMK]

As Flapjack says, cryoablation is used for pulmonary vein isolation. It uses a balloon that can be placed in the vein opening to easily target a circle of tissue and freeze it. RF (heat) ablation is typically used to target random rogue ‘hot spots’ in the atria.

Apparently I had a ‘very interesting’ ECG prior to my ablation and my EP decided it was likely that I would also have ‘hot spots’ that would need addressing so he decided to forego his cryo catheter and use RF. Since this method takes longer to isolate the pulmonary veins with a ‘circle of points’ (and the time taken to ‘map’ or survey your heart) you are more likely to have a GA.

In my case, some of the rogue ‘hot spots’ are close to the AV node so I’m scheduled for a Pace & Ablate shortly.

[Aqua_1 in reply to IanMK]

Thanks IanMK. I think I also need to check with the EP who has recommended RF why he doesn't do CRYO as the first option? I might add, he also gave me a higher success rate than the EP who recommended CRYO.

[jennydog]

I understand that 25% of people, like me, have conjoined veins entering the heart. This means a large entry hole and the cryoballoon is too small to deal with it. I was lucky to have a last minute change of EPs which meant I avoided cryoablation purely because of EP preference.

[BobD Volunteer]

As others have already said cryo has severe limitations but is always a good first tactic as most EPs can do two or three cryos in the time it take to do one RF ablation. (Average 1.5 hours against 5 hours for RF. ) Using sedation rather than GA (needed for RF ) also means no anaesthetist so cheaper all round as well.

If you go to AF Association website there is an excellent booklet on ablations of all types not just these two..

[IanMK in reply to BobD]

I have a different perspective, Bob. All other things being equal - particularly any financial cost to me - I would opt to attempt ‘right first time’.

Incidentally, my understanding from my anaesthetist regarding GA versus sedation is just that 5 hours is a long time to keep still

[BobD Volunteer in reply to IanMK]

To be honest I think the difference between sedation and anaesthetic can be a little blurred sometimes. DCCV is usually done under heavy sedation rather than GA but I have never felt or remembered anything.

Whilst I agree with your premise of right first time things ain't that easy with ablation at the best of times. For many people an early cryo ablation may well be and often is ticket . For us more complex cases life can be much longer journey.

[Aqua_1]

Thanks so much BobD!