What type of ablation has the best results?

[manabouttown]

I am going to have an ablation soon and am wondering whether to elect to have a Cryo, Radio Frequency or Pulsed Field.Plus can anyone tell me what to expect in the 3months after during the so called blank period?

[BobD Volunteer]

Thre is no "best" as such. Cryo is often used as a first attempt since it is qucker and easier for the EP and can usually be done under sedation rather than GA so slightly faster recovery. RF is frequently used as a second attempt where the balloon has missed areas or where other parts of the atrium are firing. PF is new and not available many places yet. For help regarding recovery we wrote a fact sheet as below.

healthunlocked.com/redirect...

[manabouttown in reply to BobD]

Thanks for your advice

[mjames1]

Short answer: Results identical.

I prefer Cryo over RF, because shorter, less operator dependent and at least in the US, can be done under conscious sedation versus rf which is under General anesthesia. PF is even shorter, safer and probably the best choice, if available and the ep has done at least 50-100.

One point of confusion regarding Cryo. A so-called "cryo ablation" uses both a cryo balloon for the afib pvi and it also uses rf on both the right and left side of the heart, if needed. The best of both worlds in my opinion because the cryo balloon does not have the gaps on the PVI that rf might leave. At least that's how it's done in the US (cryo and rf in a "cryo ablation") and at least with the UK ep's I've contacted. That said, something to be discussed.

Jim

[manabouttown in reply to mjames1]

Thanks Jim

[Jalia in reply to mjames1]

Three of my RF ablations in the UK were under sedation which, incidentally I much prefer to the one I had under GA.

[mjames1 in reply to Jalia]

You are lucky. I doubt you could find an ep in the US to do rf under sedation. I couldn't.

Jim

[mjames1 in reply to mjames1]

Bob, when was the last time you checked? I spoke to a cryo practioner two months ago in the UK and they use rf where needed in the same procedure.

But I think we both will agree that it's a key question to ask the ep who does cryo balloon, i.e. will you use rf on the right and/or left side of the heart, if needed?

If the answer is no, then at least in my case (I have afib and flutter) I'd go with rf or an ep that does rf with cryo.

Jim

[BobD Volunteer in reply to mjames1]

Jim as I have said before, not generally in UK.

[DawnTX]

my first was cryo-it lasted about six months and not that it failed but I was told it was a one shot deal. My second was RF and lasted over a year. I have to say I forgot I had a fib because I felt so good. I don’t know anything about the pulsed field. other than it is still new. I would think your doctor would have his reasons for choosing one over another. I can’t say I felt any different between the first two healing was relatively quick. I remember sitting up the next day, realizing I was not breathless. Everyone is different though. To me, it is the mapping of the area to be ablated . That is the key. It’s not as though your ablation falls off or anything goes wrong with it. It could simply be another spot that a fib has managed to wiggle through. The ablations I had are still intact. The problem with them is the scarring, depending on the area they have done this too. I know people that have had many many ablations. I only had three yet my EP now did not want to do anymore because I have extensive scarring. These are things that have to be thought of. My doctor does not like to keep repeating temporary fixes because of things like scarring. He tries to get a solution for quality of life as soon as possible for us because that’s all you can do with a fib anyway. It can’t be cured, but they have ways of cutting it off. Best bet is to sit with your doctor. Ask what type and why and what happens if you need more going forward.

[manabouttown in reply to DawnTX]

Thanks Dawn

[Physalis]

I had a successful RF ablation under sedation nearly three years ago. The blanking period was totally uneventful.

Apart from the migraine. However, that was due I think to the fact that I had a hole in my heart which was pushed open more during the ablation process.

[manabouttown in reply to Physalis]

hanks Physalis

[DawnTX in reply to Physalis]

interesting my first two I had no headaches, but my AV node ablation gave me a whopper of a migraine for four days. I have since found many others. I’ve had the same. I wonder if it is the length of time you are under sedation? I had had quite a lengthy procedure very aggressive last April. I don’t remember the headache then this one I don’t think I’ll forget and I seemed to have it as soon as I woke.

I hope you are doing well now

[Physalis in reply to DawnTX]

I wasn't under sedation for very long, I think it only took about an hour. I was fine afterwards until it was time to go home, I stood up and my blood pressure fell - and took about three quarters of an hour to get back to normal.

They were worried I might be suffering from internal bleeding so one of the doctors did an ultrasound. He told me that they didn't need to drill through the septum as I had a hole in the heart. I found out later that this was a foramen ovale patent.

On Google it says "an opening in the septum between the two atria of the heart that is normally present only in the foetus

During foetal life, this small tunnel, the foramen ovale, allows blood to bypass the lungs … . Yet in as many as 10 percent of people, physicians now estimate, the hole remains open, or patent."

Personally, I think this opening has been one of the causes of the migraine which I've had since I was 10 years old.

The morning after my ablation I was very ill with a sick headache type of migraine but it wore off and then I had quite a bad attack every day for eleven days. Then it stopped and I had no other problems during the blanking period.

For me, taking Apixaban has virtually stopped my normal migraine attacks. I have a theory that it enables the flap covering the foramen ovale to close more tightly. After my hip operation last month when I was on a half dose of Apixaban I had two very mild attacks.

It would be nice if someone decided to do some clinical trials to see if it helped others with migraine.

[Hidden]

In the UK it's generally either Cryo or RF for a first ablation for Atrial Fibrillation, and a PVI (pulmonary vein isolation) procedure in the left atrium is most commonly performed. The newer Pulsed Field technique is currently available at a only a few centres in the UK but it is like to increase in its availability over the next couple of years.

The form of ablation offered depend both on what's available at the particular cardiac centre and on the preference of the EP. Cryoablation is usually a shorter procedure and therefore easier to carry out under sedation, but it can fail if the cryo ballon is not a good fit for each of the pulmonary vein openings. RF is more involved as the operator needs to perform a series of RF lesions to surround the pulmonary veins. With both techniques areas can be missed and if needed a further "touch-up" RF ablation can be carried out at a later stage.

At the majority of AF is thought to originate in the pulmonary veins, my understanding is that PVI is usually tried in the first instance. If PVI fails to eliminate AF then efforts to locate and ablate other possible souces of AF within both the left and right atria are undertaken. I'll check this with my EP the next time I see them.

[Buffafly in reply to Hidden]

When I had my ablation the EP did everything at once - PVI, box and top line for flutter, I think maybe because ablation was a bit risky for me and he hoped not to have to repeat? My AF came back after two years but not so extreme so I’m on minimal medication.

[Hidden in reply to Buffafly]

Hi Buffafly, that's interesting. Was your ablation performed for paroxysmal AF or for permanent AF?

[Buffafly in reply to Hidden]

Paroxysmal - it was done at Harefield which is part of the Royal Brompton group.

[mav7]

Informative thread.

BobD mjames1 or anyone

Knowing that individual cases may vary, are there any published stats on success rates for the 3 (RF, PF, Cryo) ?

[BobD Volunteer in reply to mav7]

Success is judged as no AF at 5 years so Pulsed Field will have none so far as too new. Results depend a lot on operator skill as well so high use centres such as Barts (London AF centre) Royal Brompton et al will have higher % success than say a small unit in rural USA who maybe do one a week.

[mav7 in reply to BobD]

Thanks for the reply !

[Hidden in reply to mav7]

The Fire and Ice trial (2016) showed that there wasn't much difference between Cryo and RF in terms of initial outcomes or safety. There were less rehospitalisations for cardiovascular reasons (32.6% v 41.5%) and fewer repeat ablations (11.8% v 17.6%) in the Cryo group during a 30 month follow-up period.

Pulse field is a new technology and trials so far have had promising results.

As Bob says, the experience of the operator is likely to be at least as important as whichever technique is used.

[mav7 in reply to Hidden]

Good info, thanks !