Why is cryo ablation done 1st ?

[Lenlec]

Hi all. I’ve wondered this for a while now.

Why is cryo done first most of the time ? I read a lot that a rf ablation is needed after the cryo. Why not do the Rf type first ?

[Hidden]

Cryoablations are generally quicker and provided the tissue around the 4 pulmonary veins is fairly uniform, the expanding balloon freezes and scars the tissue in one hit per vein. RF ablations are a bit more like painting with dots, so much slower. The forum only tends to hear from folk who have had a problem with their Cryoablation but there are thousands which are successful so it’s seen to be the best way to treat AF even if it becomes necessary to have another RF ablation to “touch up” the missed bits……..

[Lenlec in reply to Hidden]

Thanks. That makes sense. So is Rf more successful then ?

[BobD Volunteer in reply to Lenlec]

RF can leave gaps but is useful for tidying up after cryo and also dealing with areas the balloon can't reach. Neither is better than the other and of course some EPs (like mine) do not perform cryo anyway. Horses for courses as usual. The main point is that an EP can probably to two cryos in the time it takes to do one RF so always worth a first try. Lots of people never need a second.

[Lenlec in reply to BobD]

Thanks bob. Yeah I’ve got a guy who comes into my shop he had af most days for 3 years. Had the rf ablation first time and has been af free for over 12 months now.

[Hidden in reply to Lenlec]

Not saying that, it’s a more precise way of scarring tissue where rogue impulses are detected by the EP. The majority of AF generates from the pulmonary veins but other areas in the heart can create rogue impulses and that’s when RF is used. If EP’s only carried out RF ablation’s, waiting times could be double what they are now.

[jeanjeannie50]

All three of my ablations were RF, have never had the cryo.

[Hidden in reply to jeanjeannie50]

Hadn’t been invented that far back………😂😂😂

[jeanjeannie50 in reply to Hidden]

Cheeky devil!

[Hidden in reply to jeanjeannie50]

Moi! 😉

[Neoneo]

I was told only two weeks ago that a cryo is used when they are dealing with AF? A normal ablation is used for all the other problems like ectopics.

[Fullofheart]

Saw EP about 4 weeks ago and the response from flapjack is pretty much what I was told. On list for cryo. EP explained it as flapjack does and also explained MIGHT need another procedure, but might not. 🤞

[KMRobbo]

Cryo ablation worked first time for me. Just gone past 4 years with no AF. I dont take any drugs ( since May 15 2018).I am not medically trained but as the heart is monitored during the cryo they know it has been succesful.

My EP told me in the recovery room it was succesful. I could see the screen when they were working on me so I know it was being monitored.

I suspect you can have breakthough with either RF or cryo. It most be really difficult joining all the dots using RF!

Best wishes

[Lenlec in reply to KMRobbo]

My ep said it was a text book procedure and the notes I’ve got say pvi confirmed post ablation using achieve pv catheter

[MarkS]

I had both in the same ablation with Prof Schilling. The cryo sorted out 3 of the 4 pulmonary veins, but the 4th was too large and the balloon would have gone in too far and caused phrenic nerve palsy a serious complication of cryo ablations. So that vein was sorted with RF as was another area, the ligament of marshall, that can only be done with RF. That was 11 years ago and virtually no AF since.

If I had to do it again and without the combined procedure I had, I would probably start with cryo as it is fairly straight forward. But a lot of less experienced EP's use it and that can cause problems. Then if that didn't work, go for RF. But, unlike many surgical procedures, the experience of the EP contributes greatly to the success rate.

[Lenlec in reply to MarkS]

Good advice cheers.

[Jajarunner]

The success rate for cryo is quoted between 50-70 percent. I've often wondered the same thing! It's quick, cheaper, easier to recover from and minimal damage to the heart I assume.I've just had my third ablation, just 20 MTHS after number 1 and 8 MTHS after number 2 and just wish they frazzled the whole lot in the first place. They have now redone three of the four pulmonary veins but I suppose they would have needed redoing either way. But it is tedious to take a good four months each time to feel better....

[Lenlec in reply to Jajarunner]

Does cryo do less damage to the heart than Rf then ?

[Jajarunner in reply to Lenlec]

I think I meant four cryo burns is less burning than doing that AND some other stuff . On the second ablation they burnt some extra lines across heart just in case..Still didn't work though 🤣🤣🤣

[Lenlec in reply to Jajarunner]

It’s a bloody lottery sometimes isn’t it

[Jajarunner]

Let's hope we both win then 🤣

[Lenlec]

Yep. Well I’m seeing a top ep private tomorrow. Hope it’s money well spent

[Breezera]

With my history of stomach issues (i.e. GERD, h-pylori infection causing gastritis, nutcracker esophagus), my EP recommended cryo ablation. He explained that with RF ablation there's a greater risk of injury to the esophagus, with the principle concern of a fistula being caused by the procedure. An atrial-esophageal fistula is a rare but often fatal complication of catheter RF ablation.

I had my PVI cryo ablation 3-1/2 years ago to address my worsening PAF condition and it was declared a total success - I've been in blissful NSR ever since with zero episodes of AF. So very thankful/appreciative to have had my QoL restored. 😀

[Lenlec in reply to Breezera]

That’s good to hear. Some are more fortunate I think.