Dilema. Please help.

[Daisaku]

Cryo vs RF? 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?

[BobD Volunteer]

I understand both camps to be honest.

If you are in AF all the time then a cardioversion first to se a) if you can attain NSR and b) if you feel better for it are esential.

If NSR can not be caused then ablation is unlikely to be successful .

Each of the methods (Cryo or RF ) have advantages and dissadvantages. Cryo is quicker and easier to perform and because it deals with the four pulmonary veins (PVs) where it is thought most rogue signals come from, it often works well. On the other hand it can't deal with any signals coming from elsewhere in the atrium, nor any odd shaped or conjoined PVs. It is very common for people to have a cryo first follwed maybe six months or a year later by an RF ablation to tidy up those areas missed by the cryo.

Since you are in USA I would say the most important thing is which EP is the most experiecned and successful?

[Singwell in reply to BobD]

Two really useful bits of ingo Bob.

[Daisaku in reply to BobD]

thank you.

[Singwell]

Bob's advice is good. Did you ask about number of procedures a year and success rates? You're totally entitled to that info and they should be able to provide easily

[DKBX]

Both should talk to each other! A cardioversion before doing any kind of ablation is good advice. Cryo is generally a good idea for first ablation. Checking heart health prior to any ablation with a CT scan is also SOP. It’s not an either/or but a both/and situation you’re in. However, the two docs need to get together with you in the room and formulate a plan together … IMHO.

[Madscientist16]

In the US, it is usually cryo first and then RF as a follow-up, if needed. Fewer RF ablations are successful the first time around vs cryo-ablation.