RF ablation or Cryo ablation?

[Lilypocket]

Hi

I finally saw an EP last week. He works in the department of a heart hospital that specialises in arrythmia. They do about 300 ablations a year and have a good reputation. However I was suprised when he said that they only do RF ablations and he had a slightly negative opinion of "Ice". Basically he feels that Cryo ablations being "less complicated" were carried out in general by practioners who sometimes lacked the expertise to do RF ablations and didn't do many operations. I had understood that "Ice" was quite successful for PAfib and the success rate was pretty much equal to "Fire". He also stated it was not a cure but would put off permanent Afib and alleviate symptoms. So now I'm confused! Is it worth having an ablation and if so which type? I have frequent (a couple of times a month) short (no longer than 4 hours but mostly less) episodes that resolve on their own. But I know the episodes will get get worse. Even if I have an ablation it seems I will still have to take medication....What a jungle! I am female Chads score 1 about to be 64! I would appreciate any advice

[Hidden]

I have had both and my take on it is this. It is generally thought that in most cases, the rogue electrical impulses which cause AF occur around the entrances to the four pulmonary veins. If the tissue there is fairly regular and smooth, it is relatively easier and much quicker to carry out a cryoablation. A balloon fixed at at the end of the catheter is located at the entrance point and it’s expanded to fit around the tissue and then freezes the tissue to form a scar. If there are no other rogue impulses and balloon effectively treats this area then it’s job done, but unfortunately, this isn’t always the case. In my case, the EP experienced a problem with one of my veins so I had to have a second “touch up” RF ablation a couple of years later. I’m not medically trained, but I don’t think one method is considered inferior to the other, it really just depends on the structure of the heart.

Arguably, a RF ablation will more flexible at dealing with any abnormalities, but it will take longer and almost always involves a general anaesthetic. Only you can decide whether to proceed or not and you will always get arguments for and against. For what it is worth, it’s probable that I will need a third and I’m on the list, just in case. So you can guess what I think, but don’t let that influence you....😉

[Lilypocket in reply to Hidden]

Thanks for replying Flapjack. Did you get relief from your 2 ablations and are you still taking medication? The difficulty for me is I feel ok right now so it is difficult to project into the future to a scenario where the symptoms have become much worse and the AFib permanent and it will be too late to consider an ablation. Some people have 1 ablation for Paroxysmal Afib which works and resolves it in 1 go. When is your 3rd one ? I shall read your story in any case. ☺️

[Dawsonmackay in reply to Lilypocket]

I've had three RF ablations. The third one being successful. The other two, I reverted into Afib within a few days.

[Hidden in reply to Lilypocket]

You seem to be well enough informed to know that AF affects everyone differently so my experiences will probably be very different to yours. All I can say is that with a bit of help from Flecainide as a pill in pocket, I have been largely free from AF since September 2014 and episodes have been less severe. Currently take Apixaban and a relatively small dose of Diltiazem. Expecting to be notified around July.......

[wilsond in reply to Lilypocket]

You have exactly the same dilemma as me! I have improved in terms of symptoms and frequency and my EP Proff Osman and I decided that I wouldn't benefit from ablation at this point. To review in March 2020.

It's so difficult to know what to do isn't it?! Sorry I don't have any answers!

I didn't realise ablation can put off permanent AFib / flutter .I have both.

I thought it was about quality of life only.

Another consideration !

If the decision was just made for us maybe we would be better off! In an acute surgical need after all,we don't have time to consider..

Best wishes x

[Lilypocket in reply to wilsond]

Hi thanks for your reply! Yes the EP I saw ( for the first time) wanted to make sure I understood that it wasn't a magic bullet. But also they have to say that don't they? But I think for "simple" Lone Afib it works well ( if there no other underlying problems)and there are many success stories! It is just the decision to go ahead when I' m not really suffering from the episodes yet is a tough one! 🤔

X

[wilsond in reply to Lilypocket]

Exactly! I do sympathasise...between a rock and a hard place as my Nan used to say

[Lilypocket in reply to wilsond]

So true! Please let me know what your professor advises in March. I'm seeing my cardiologist in March to discuss what the EP said. X

[wilsond in reply to Lilypocket]

I will do,please let me know how you get on too! I see mine 31st.xx

[jennydog]

I had a RF ablation with GA and am glad that I did. Like 25% of the population I have conjoined veins entering my heart as a large hole which is too big for the cryo balloon.

[Lilypocket in reply to jennydog]

Thanks for replying! Yes I think this is probably what is behind this specialised unit just doing RF. Both " fire and ice" have fairly equal results but with RF if there is an unexpected situation they can deal with it at the same time.

How many have you had and did it/ they work?

X

[jennydog in reply to Lilypocket]

Just the one. I cannot have another as they found fibrosis in my left atrium caused by radiotherapy to my left shoulder.

My AF is now much milder and can be controlled by 100 flecainide as a pip. I have no regrets about having an ablation. If you are offered it then it's a no-brainer. It's a £15,000 procedure and not offered lightly.

[Lilypocket in reply to jennydog]

Thanks Jennydog! I'm just if that would work for me as I have more breakthrough episodes since I switched to Flecainide but they they are less symptomatic and shorter but my cardiologist said that I'm a candidate for ablation as two types of drugs haven't stopped the Afib's progress .

How was your recovery and how often do you have Afib episodes compared to before? X

[jennydog in reply to Lilypocket]

I can go 3 weeks between episodes then could have 2 within days. I don't know what happens when I'm asleep which is when a monitor once picked it up. Beyond stress, I cannot identify a trigger

[Lilypocket in reply to jennydog]

I don't think there any triggers. I've tried cutting out many things with no difference. I can have an episode as I wake up in the morning, at night,

In the day etc. So I've started drinking a glass of red wine in the evening again ( which doesn't provoke an episode). It's QoL in the end. I'm not very symptomatic so I can wait a bit to decide but it's a bit Russian Roulette - if I leave it too long it may be more difficult to have a successful ablation. X

[MarkS]

I had a combined RF and cryo ablation in one procedure. The PVs were ablated first with cryo, but the balloon would have gone in too far for one PV so that had to be done with RF. Then there were some other bits like the ligament of marshal that needed sorting, which as also done with RF. That was all under sedation which was fine.

I can understand that cryo is carried out by less experienced operators as it's cheap and cheerful. However the risk of phrenic nerve injury is higher.

[Lilypocket in reply to MarkS]

Thanks for reply! So in fact having RF only is in some ways avoiding a higher possibly of having a second ablation ( for Lone Afib) as more complicated issues can be dealt with if they arise. Great you are still Afib free 🤗

[Hidden]

My EP would only do RF as he is able to target the hot spots much better than the one size fits all cryo method.

It takes a lot longer, I was in the lab for 5 hours but almost three years later I am still in NSR

[Lilypocket in reply to Hidden]

Thanks for replying Mikee. So in fact this is probably the norm in centres that do a lot of ablations. How was the recovery? X

[Hidden in reply to Lilypocket]

I felt great for the first 10 days but then palpations hit big time. I was still in NSR but they were horrible.

I still have odd days when I get runs of palpations or will get bigeminy all day. And I still feel a missed beat or two most days.

Fitness took several months to get back to pre ablation levels.

I'd do it again in a flash if I needed to

[Lilypocket in reply to Hidden]

Can't you have another ablation for the palpatations ( flutter??). For myself that's what I'm worried about -exchanging one rhythm problem for another lol Also I hate PVC's when they can be really felt. Got rid of mine when I changed drugs x

[Hidden in reply to Lilypocket]

It's not flutter, just PAC/pvc

Not bad enough for ablation, and I'm not sure they would ever do that just for benign palps?

[Lilypocket in reply to Hidden]

Are you still taking meds? Flec stopped my symptomatic PVCs . The Holter showed I still had them but I couldn't feel them like before. Yes I think they can do ablations for PVCs but if everything is going fine for you not much reason too I suppose 😊

[Hidden in reply to Lilypocket]

No, I'm on no meds for AF and I want to keep it that way. I'm used to the palpations now so they don't worry me or cause any issues .

[Dodie117]

I had RF in 2013. It took 5 months for arrhythmias and bumps to settle down but then- no more AF. I am on no medication except anticoagulant so feel very lucky.

I think all of us were in your shoes as the hardest part was making the decision. If you trust your EP maybe put yourself in his hands.

Good luck 🍀

[Dangerousdriver]

I had both at once.

[Lilypocket in reply to Dangerousdriver]

👍And did they solve your problem?

[Dangerousdriver in reply to Lilypocket]

Yes and no, since I had the ablation I haven’t to go to hospital, but I’m still getting brief runs of a-fib, SVT which is a pain. I’m pushing to have a second touch up ablation.

[Lilypocket in reply to Dangerousdriver]

How long ago was your ablation?

[mullens41]

I got the cryo balloon ablation a year ago. After a few episodes during the blanking period, I haven't had any episodes in 9 months. I do however have numerous PACs which are very annoying. Had another ablation to take them out but unfortunately my heart didn't misfire once during the procedure. If it keeps up I can try again in 3 months

[Lilypocket in reply to mullens41]

Thanks for your reply. Great that it worked and I really hope you manage to eliminate the PACs. I had thousands of PVCs a week that I could feel and though benign were very tiring. They stopped when I changed coincidentally to Flecainide for the Afib so I can sympathize. I now have PACs but I don't feel them like the thumps I had before.Take care