Need to decide.

[Daisaku]

Cryo Ablation vs RF ablation? Thought? Older EP vs younger EP?

[MarkS]

I would go for both if you can. I had a cryo balloon to treat 3 of 4 PVs. The 4th was too big so required RF. Then there were additional areas which could only be treated by RF. That was all carried out in a single procedure. I would go for a very experienced, middle aged EP!

[Daisaku in reply to MarkS]

One one the EP is older and wants me to do a Cardio version with an antiarrtythmic first to see if it works, he is the cryo guy. The other guy is maybe in his 40's and wants me to do a CT scan to see my heart first. The Cryo guy ablation would be end of april, the RF gut june 1st. What to do?

[MarkS in reply to Daisaku]

I see you are based in the States. The problem there is that the average number of ablations per EP is much lower than in the UK according to a Medscape article I saw a year or so ago. So it is really vital you find someone who does lots of ablations, e.g. 150+ p.a. You need to question both guys about the number of ablations, success rate and number of adverse events and if they don't measure up, be prepared to travel.

Of course, you do need to make sure there aren't any lifestyle factors exacerbating the AF before you have anything done, otherwise it would be money down the drain.

[Daisaku in reply to MarkS]

I have done just that and changed my diet completely and lost 20 lbs so far.

[Singwell]

Success rate and number of procedures a year are your yardsticks. Ask. Less than 50 procedures - avoid.

[momist]

I thought that would be a decision made by the EP? The usual practice is a cryo ablation first, which is a bit of a scatter gun effect around the needed area, and a follow up ablation later if necessary with RF to pin point the remaining leakage, if they can find it.

However, I'm no expert, and you should talk to them. EPs are the experts.

[Snowgirl65]

Cryo is usually the first plan of action; RF cleans things up at a later date. I fired my older EP who did my Cryo, and got a younger one for the RF. I feel the young ones are more up to date on latest techniques, as the older ones don't really have time to retrain because of their patient load. Just a thought.

[Bolander]

The old saying is that you should use an older lawyer, but a younger doctor, as they are likely to be more up to date. Maybe in this case you need both experience and familiarity with the latest developments?

[Bluetonic]

Maybe different because I'm in the UK , but my EP, I guess early 40s but age really doesn't matter to me. He wanted to do RF ablation as he could pinpoint the required burns better.

5 years this month since ablation and AF free.

[seasicksurf]

Had RF ablation about a year ago. All clear and AF free since. My procedure included PVI and a "flutter line" (scar line at back of right atrium). Doc humbly said his success rate was "higher than normal" because he started doing flutter line with PVI because about 20% of patients came back with atrial flutter, so he does both with initial procedure now. I'm in US and larger institutions (from what I can tell) most commonly go with RF.