Cryo vs RF

[jgolay]

Hi,

I’m in Western Massachusetts, US deciding between having cryo with my regular EP in Hartford, CT or RF with department head in one of top 2 Harvard hospitals in Boston, MA. After waiting for an appointment for over a month, they both gave me appointments last Monday. I’ve had esophageal issues, which makes me lean toward cryo (plus it’s an hour vs 2 hour drive) but I can’t help but second guess myself about giving up the opportunity to be treated by someone who does two RF’s a day (while my local EP does two cryos per week). Mostly I’m grateful as I frequently have heart rates of 160-220 and am getting more frequent SOB. Thanks!

[BobD Volunteer]

You need to understand the differences and how each can affect your AF. If this is simple adn the rogue impulses areb onoy coming form teh four pulmonary viesn then cryo is a good way to start. the problemis that if your heart is not nicely ssymetrical, or you may have conjoined viens then it will not be fully effective.

Many people find that they subsequently need RF ablation to the areas where the balloon can't reach at a later date.

If youi go to AF Association website there is good booklet on teh various procedures. Personally regardless I would always go with experience.

[jgolay in reply to BobD]

Thank you, BobD. The booklet was excellent. You’ve shed-more light on this topic which is very helpful.

[Hidden]

Bob needs to change the oil on his new laptop or get one of his boys to sort out the spellchecker....😂

I’ve had both types and from the patients perspective, I didn’t find much to choose between the two procedures. The cryoablation is often quicker and is generally done under sedation so it’s possible you may be more aware of what’s going on and you could experience some discomfort but if you make the team aware, they normally up the knock out drops. The recovery in the hospital could be quicker too, particularly if you react badly to general anaesthetic which is more frequently used for an AF ablation but the main benefit is no pain or discomfort during the procedure.

In the UK currently, as Bob says, cryoablation tends to be the preferred method unless it is previously known that there are some issues regarding the structure of the heart. Because the cryo balloon can miss bits, it’s not unusual to have a follow up RF ablation to touch up the missed bits which is what happened in my case. I think more sophisticated mapping techniques are used in RF ablations therefore it would seem logical that “touch ups” are less frequently necessary, but that’s just an assumption on my part.

[BobD Volunteer in reply to Hidden]

Damned dyslexic key board FJ.

[jgolay in reply to Hidden]

Thanks, Flapjack. There’s nothing like personal experience! In this area, we have general anesthesia for both cryo and RF so perhaps the recovery will be similar.

[perkman]

I had RF ablation 17 months ago. It was under sedation and I've been afib free 14 months now. I had a highly experienced EP.

Like Bob says go with experience. The drive shouldn't be considered a factor

[MarkS]

I had both in the one ablation at the London AF centre. First cryo but that could only do 3 of the 4 PVs as the 4th was too large and the balloon would have gone in too far and caused PV stenosis. That was sorted with RF, after which the ligament of Marshall was also RF'd (cryo cannot ablate that). This was carried out by Prof Schilling who is an expert in AF ablation 8 years ago, and is still holding (where's that wood!).

[Stinky1953]

I've had both. First was cryo which lasted 5 years. Next 2 were RF, the last being in Dec 17 and apart from one recent episode, triggered by a bad reaction to Chemo, I've been AF free. The reason my two latest were RF is because my EP told me he can be far more targeted with RF which was necessary for my situation.

As Bob said it will depend on where the impulses are coming from. And also I would go with the man who does it every day rather than the part timer.

All the very best and I hope it all works out for you.

Tim

[jgolay]

Thanks, everyone! Some older related posts popped up after I posted this and I got a lot out of them, too. I decided to go with cryo this time and feel good about it knowing that RF is a future option if needed.

[barabas]

I had RF from EP doing multiple procedures a day (in US). Cryo was never discussed, but probably should have asked him why not Cryo. I would ask the Cryo EP why not RF, and the Harvard RF EP's why not Cryo....and see what they say. As others have said, would also seek out someone who does a lot of these procedures, whether RF or Cryo.

[jgolay in reply to barabas]

Thanks, barabas. Great question! My understanding is that sometimes the choice of cryo or RF is personal preference. Based on BobD’s input, I asked my local EP more questions. He said he’ll do Cryo and, if he can’t get everything with it, he’ll use RF as needed. That sounded good to me. He hasn’t seen my CT scan yet, which should provide more info about what might be needed.