Can someone explain the pros and cons of cryoablation and RF ablation?

[Lilypocket]

Hello

I have PAfib and am considering an ablation. Any info would be welcome especially success stories 🙂

Thanks!

[CDreamer]

Cryoablation is when ablation is done by freezing whilst RF = Radio Frequency. Both achieve the same affect = makes scar tissue around the pulmonary veins which creates a barrier that blocks the rogue signals which cause Af. Cryo uses a ring which covers the size of the Pulmonary vein & is done in one go so the procedure is done quickly whilst RF uses a much finer instrument & therefore often takes much longer - but is often more precise. Often people have a cryoablation 1st - if not 100% successful - it will be followed up using RF ablation.

Go to the AFA site for more info.

[Lilypocket in reply to CDreamer]

Thanks for your answer! Is RF more risky?

[Hidden in reply to Lilypocket]

Not really, the risks for both are similar but RF takes longer. I’ve had both and I’m still breathing........

[Lilypocket in reply to Hidden]

😂

Was it ultimately worth doing?

[Hidden in reply to Lilypocket]

👍

[Lilypocket in reply to Hidden]

That's a "yes" I take it 😊?

[BobD Volunteer]

Cryo ablation uses a small balloon which is fed via catheter into the entrances of the four pulmonary veins (from which many signals emenate) and then uses a freezing gas to create the burns which block the rogue impulses. It is faster than RF which as CD explains is more focusses and often used for simple AF. It can not be used to get at other areas within the heart which may be firing off nor when people have strange shaped or conjoined pulmonary veins. It is therefor limited in what it can do which is why you often hear of people having a cryo ablation which may slightly improve things and a follow on RF one to tidy up any missed areas.

There is no best method but Cryo is often used as a first attempt as it only takes about half the time taken for RF.

[Lilypocket in reply to BobD]

Thanks Bob! Have you had this procedure yet?

[BobD Volunteer in reply to Lilypocket]

Had three RF for AF and waiting a fourth for atrial tachycardia. No AF since 2008. Cryo was pretty well unknown when I had my three ablations.

[Lilypocket in reply to BobD]

Ah ok. Is Atrial Tachycardia the same as Flutter? Do you have it on and off or all the time...and last question was it provoked by the ablation or nothing to do with it?

Thanks for your replies 👍

[BobD Volunteer in reply to Lilypocket]

No to both as far as I understand. A Tach is in left atrium, flutter usually from right. Ther are all arrhythmias but not all arrhythmias are AF!

[jennydog]

I am one of the 25% of the population who have conjoined veins entering the heart. The cryoballoon is not big enough to cope with such a big entry hole effectively.

[Lilypocket in reply to jennydog]

Did you have an RF ablation?

[jennydog in reply to Lilypocket]

Yes.

[smwdorset in reply to jennydog]

How interesting I too have one conjoined PV but I had Cryo which seems to have worked (three years on)

[Chris267]

I had a cryro on March 5th 2019. Worked great. In and out in 2.5 hours, went home the same day. Was having daily fib runs now have none. Funny beat now and again but huge improvement. Has lots of PAC's but they are mostly gone now too. Good success and on zero drugs now.

[Lilypocket in reply to Chris267]

Yes I heard the PACs are the heart healing and sorting itself out after the operation. Glad all went well for you .

[Hidden in reply to Chris267]

Hi just read your post from a while back, how was the recovery from ablation (thinking of having one), thanks Andy

[Morzine]

I had cryo...allthe worrying was before and now I know it was unnecessary....before you know it your home resting....rest is the key thing for after.....felt pretty normal the next day.....but had energy dips and highs as time progressed and the healing took place...you must listen to your body.......I’d say I’d do it again in a jiffy......I’m now six months and had no afib,...being weaned off tablets...

[Lilypocket in reply to Morzine]

That's fantastic news! So pleased it's worked for you.

X

[Hidden]

I had an RF ablation 27 months ago for AF and flutter.

My EP chose RF because it gives him more control on where the burns are made.

The pros are no more dibilitating AF, no more rate and rhythm drugs

[Lilypocket in reply to Hidden]

Great! so it worked first time! I heard that RF can possibly provoke rhythm problems but is more effective when it works than cryoablation.

[Hidden in reply to Lilypocket]

my understanding is that RF is more precise than cryo, it takes longer though.

I was lucky that I had an exceptional EP that wanted to get this AF gone. And the hospital were using the latest 3D mapping to find the hot spots.

[ellie58 in reply to Hidden]

Does it make a difference which hospital you go to for treatment? Is there one that has better results than others?

[Hidden in reply to ellie58]

I have no idea, but I felt good in the knowledge that my EP was great and the hospital used the latest technology

[Brizzy50000]

I had my ablation on the 2nd of May 2018 using RF for AF and Atrial Flutter the op took about 4 to 5 hours, I was sedated but awake until near the end, woke up on the way back to the ward overnight stay at Bristol heart institute, home the next day, plenty of rest for the next month luckily I'm retired so that wasn't a problem, off all meds except anticoagulant rivaroxaban after three months and of course the best thing no AF or flutter since

[Lilypocket in reply to Brizzy50000]

I'm pleased for you ☺️

On the other hand I would prefer not to be awake for it 😱

[Brizzy50000 in reply to Lilypocket]

I was of a similar thought but the wait for ablation with GA was longer so I went for sedation it was ok a little uncomfortable at times but not painful and if you are a bit twitchy they will turn up the happy juice, I personally think recovery is quicker with sedation, but whatever you choose good luck and I hope all goes well.

[smwdorset]

I am afraid I cant comment on the pros and cons of each as my EP only offered cryoablation. I do remember however him saying that the statistics showed that there was a higher percentage of first time success for cryoablation though not necessarily overall. I am of course only a sample of 1 but I had a PV cryoablation three years ago after 14 years of paroxsymal PF that then became persistent (and wouldn't respond to flecanide) and I havent had AF since

[Lilypocket in reply to smwdorset]

Thanks for your interesting answer. I feel inclined to go for cryoablation as well. The only thing thing that worries me is the ultrasound to check behind the heart for clots which you have to swallow. I choke eating fondue swallowing the stringy melted cheese!

[cuore in reply to smwdorset]

With such a success , you must have been only one or two months persistent.

[KMRobbo]

I had an ablation 29 Jan 2018 left atria cryo. Never had a fib since. Not any issues with the procedure. Light sedation only. Unfortunately developed 're entrant' atrial flutter right atria 8 days after , nothing to do do with the ablation most probably to do with the flecainide I was still taking. ( it promotes flutter apparently). A second RF ablation 26th Feb stopped that. Again no problem with the procedure. Came off all drugs may 15th 2018. Brilliant. Been AF & flutter free since! I do get ectopics. Usually for seconds , some times for minutes on a few occasions have lasted for hours. Had a run of long episodes in jan 19. My EP is not concerned. I just try to ignore them and usually succeed.

For all I know i had them before AF and never noticed! AF makes you hyper sensitive to all heart feelings!

I was 57.5 years old when I had the ablation. Fit apart from the AF.

Cured? Who knows I am for now! Not worrying about it. Worry makes everything worse. If I get AF tomorrow morning I will happily have another ablation tomorrow afternoon.

Anything else you need to know just ask!

Best wishes.

[Lilypocket in reply to KMRobbo]

Thank you for your detailed reply!

Best wishes to you too and I hope you stay in NSR.

[Nanabrodie]

I had cryoablation for my af in April 2017 but it only worked for 9 weeks and when it returned I had it more often than before so I went back in the August of that year and had an RF ablation under Ga and have been absolutely fine since, in fact I had my 6 month check up last week and they don’t need to see me anymore. The only medication I now take is an anticoagulant .

[Lilypocket in reply to Nanabrodie]

Thanks for your reply. That's interesting but at least it worked second time around.

Best wishes

[IanMK]

I had an RF ablation last year to treat a complex arrhythmia from an unclear location. It involved a TOE and I had a GA. Nothing at all to worry about with either and most people who have sedation instead of GA are barely aware. Unfortunately for me, this ablation was unsuccessful as it was discovered at the time that the sources of my arrhythmia were very close to my AV node so my EP needed to discuss the options with me. My second ablation (3 months ago) was to target sites close to my AV node and there was a high likelihood that my AV node would be compromised. My EP did a fantastic job but I also now have a CRT device as a ‘crutch’. My symptoms have gone and I feel so much better. I am so glad I took this route although I will now need regular routine replacements of my pacemaker(I am 64). I am waiting to see my cardiologist again in 3 months time and hoping he will let me stop my heart meds.

[Lilypocket in reply to IanMK]

Hello Ian

Thanks for your reply. Don't they do amazing things now to try to get us out of these situationsI have Paroxsymal Afib and am trying a second drug but after 4 weeks have had self resolving episodes of AFib. I am heading for ablation and it is wonderful to be able to talk to people in the same mess. I am 63 and I don't know anyone with this so I feel a bit lonely sometimes ( I'm a widow). Your situation sounds complicated but good EPs love a challenge and will find a solution for you.

Take care

[AIW58]

Hi I had a RF ablation using 3D mapping end if March under a GA.

Recovered without any problem (apart from some episodes of the visual aura in first week-see info sheet on this site and an hour or two of frequent ectopics one evening).

Off Flecainide and feeling fine no issues at all. I'm 59 and had lone PAF.

Good luck

[Lilypocket in reply to AIW58]

What is the difference between lone AFib and Paroxsymal Afib or is it the same thing?

[AIW58]

My understanding is that lone AF just happens not associated with things like high BP, or sleep apnoea or being overweight. I had PAF but it was called lone because I had none of the things I mentioned.

[Lilypocket in reply to AIW58]

That's me then. There are no triggers and up to now it stops by itself without cardioversion. I think it is supposed to lend itself to ablation as it predominantly comes from the PV. Fingers crossed!

[AIW58 in reply to Lilypocket]

Yes my episodes always terminated spontaneously after 2-4hours. EP was happy with how it went so I really hope I get a few years AF free. Maybe forever if I'm lucky. 😀

[Lilypocket in reply to AIW58]

🤞🤞🤞

[Hidden]

Hi Lily pocket, When I had my first ablation in 2013, my EP used both cryo and RF in the ablation. It did stop the AF for 3 years, but then it came back.

My understanding was that he used cryo where it made sense, as in covering more territory more quickly, and then RF where it made sense, to get the other spots.

When I was considering getting this ablation back then, I put lots of energy into analyzing these approaches, questioning him so much and also talking to a friend of a friend who was very knowledgeable about the technology. He had advised against cryo, which I believed was fairly new at that point.

I didn't listen to my friend. My EP knew what he was doing and I trusted him. I thought it was pretty cool that he'd figured out a way to use both technologies most efficiently.

After AF returned, I went for a 2nd ablation, which didn't work. If I choose to get a 3rd, it will most likely be the FIRM ablation I wrote about recently, which uses new technology to target the spots where AF originates, which can mean looking in places that typically aren't looked at in typical ablations.

Here's wisdom I gained; just my lesson, which I am not aiming to hit anyone over the head with, but which has made a difference to me. Maybe it might help someone else.

Looking back, doing all the research on the different types of ablation beyond the basics was my attempt to control a situation that was rather scary. I have not done that since. I felt it was really helpful at the time.

The reason I'd get a FIRM ablation if I need to and if I can is that my new EP is the first to truly listen to me and "get" me. Now I tend to be looking for that kind of connection, having assured myself that the doc is highly skilled technically, rather than digging into the technical details of the procedure. His suggestion that this technology, though somewhat controversial, may well be just the right thing for me, feels intuitively right to me.

I understand how it works at a basic level, will do my best to work with the guy who invented it if I end up needing an ablation, and otherwise I'll continue to direct my researching chops in the areas that have helped me the most, such as metabolic cardiology and various ways to adapt my lifestyle and nourish my heart.

It's been an interesting lesson to learn.

Best wishes to you!

[Lilypocket in reply to Hidden]

Thanks for your reply! I don't know about FIRM but then I'm just a "beginner" having not even had a first ablation. I live in France where most of not all these techniques were pioneered. At the moment I'm seeing a cardiologist but if things get worse he has agreed to refer me to an EP. Very good heart clinic close my home with a reputable rhythmology section. So I'll go there eventually. I hope the best for you ☺️

[Hidden in reply to Lilypocket]

Yes, there's always Bordeaux! I believe that they were pioneers of the ablation, yes?

I hope you find just the right solution.

[Lilypocket in reply to Hidden]

Thanks! X

[Hidden in reply to Lilypocket]

You might consider looking in the work of Dr. Steven Sinatra, Metabolic Cardiology, as you consider what course of treatment is best for you. I've written about it in other posts. There are supplements that basically nourish the heart. I've found it helpful, as have others.

[Lilypocket in reply to Hidden]

Ok I'll take a look ☺️

[cuore in reply to Hidden]

You are correct; it was Michael Haissaguerre who initiated the procedure in 1994 with his assistants Pierre Jais and Meleze Hocini, all at Bordeaux. They are also the leaders in ventricular fibrillation. They publish more articles than Mayo clinic.