I was dx with Paroxysmal Afib in 2018. After the usual regimen trials of just Metoprolol, Flecainide, Flecainide with Metoprolol for rate control, etc. I received a Cryoablation on March 16 of last year (2022). I had two afib episodes a month or so after the ablation which was explained as being in the "Blanking Period". Arter that, I was Afib free for over a year until just three weeks ago. After my Ablation I have still been on 50 mg. Flecainide x2 daily, having dropped the Metoprolol. After this recent episode, the Cardiologist added the Metoprolol, 12.5 mg x day back in. I thought that would work until yesterday when I had a short episode of only a few minutes in the afternoon and then, a 2-hour episode last night. The main variable this time was I had the high dose Senior Flue Shot on Friday which caused mild flue-like symptoms yesterday.
I saw a Cardiologist just the other day who told me I am very healthy -Appropriate BMI, No Diabetes, No Heart Disease, Blood Pressure good, physically active, etc. and not to worry because any symptoms that might re-occur can be dealt with. He mentioned a new kind of Ablation that uses neither heat or cold, "Pulsed Field Ablation" and advised me to wait a bit until it becomes more developed.
QUESTIONS:
1.) Does anyone know about or have any experience with this procedure?
2.) Being that statistics show a second ablation raises the success rate quite substantially, have others knowledge or experience about this?
Thank you.
Written by
willec49
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I had three RF abalation before my AF was terminated in 2008 but went on to develop a different arrhythmia which needed ablating in 2019. PFA is still new and currently not showing any real benefit over other methods according to a recent study.
Yes, the Cardiolgist I saw a few days ago mentioned PFA to me and said pretty much the same thing - that it is still in the development stage and, by the time I might need another ablation, it might be more reliable. I just feel that, if I am going back to where I started before the ablation, rather then going through the same medication regime as before, which didn’t work, why not just go for something that has a real statistical track record of improving the situation - a second ablation.
My situation is not too dissimilar to yours. I had a Cryoablation which worked fine for a couple of years but because the EP was unable to fully treat one of my pulmonary veins, I had a second RF ablation which has held reasonably well. It did play up after about 8 months but after some treatment for an overactive thyroid, it settled. It’s not uncommon to need a second ablation to treat any missed bits but I’ve no idea about the success of a PFA. It might be worth discussing with the EP who did the Cryoablation as he could check to see if there were any difficulties at the time. As Bob has indicated, some need 2 or 3 and even then there are no guarantees but even if AF should return, symptoms tend to be much milder. So far, we have not had many posts from folk who have had a PFA so there is not much most of us can say to help you directly but see what you can find out more from the medics who have treated you and therefore have a better understanding of what might be best for you…….
Hi flapjack, what is cryoablation and RF? Thé diference? I haven’t a clue which one I had in 2019 as I don’t think I was told or the paperwork said, I’m in France.
My afib came back a couple of weeks bavk, I saw the cardio, she said I could have another ablation and I’m now on the list.
Cryoablation is when the rogue tissue in the heart is frozen and a Radio Frequency ablation is when they burn the tissue. For Cryoablation an expanding balloon is used to freeze the tissue around the entrance of the 4 pulmonary veins where the majority of AF emulates from. In simple terms, It works fine as long as the tissue is relatively smooth which is not always the case, hence the occasional need for an RF ablation which is a slower process and can be better targeted at all areas within the heart which could cause AF. Hope this helps, I’m sure others will add their comments…….
Thanks for that …..I wonder if I had cro as I had plastic in tubes filled with water all around me and the room was very cold….I think my trolley was a water bed….is this the same in uk this was France at Lyon hospital…
I had the cryoablation in March of last year and episodes of Afib have returned so I messaged my Cardiologist today to request a second ablation. I hope he will agree but he may want to wait and see at first.
There was a thread about PFA a few days ago. Apparently tests have not shown that PFA is better than RF and in some ways not as good which is why your EP is suggesting to wait a bit if you wanted to go for that. As AF tends to snowball it probably makes sense to have the second ablation as soon as possible if you want to have one.
Here's the recent article on PFA that Buffafly just referred to. It's written by the respected EP Dr John Mandrola ... medscape.com/viewarticle/99...
It's a Medscape article, and you might have to join Medscape to read it, but that's free, and I have had no negative consequences from joining. Definitely worth reading.
There have been many Forum members hoping that PFA would be an immanent step forward, but this article suggests that a bit more patience will be needed.
I do enjoy and even agree with many of Mandrola's opinions, but he is an outlier ep, who has been rightly or wrongly critical of ablation technology in general for years. Therefore not surprising he's "underwhelmed" by PFA because it's still an ablative technology. What he is looking for is something we unfortunately do not have right now.
I therefore suggest anyone offered or interested in PFA should do their own independent research and not rely simply Mandrola's take of the study. I think you will find that the other papers show it to be similar in both efficacy and safety to RF and Cryo with shorter procedural times. And because it's still new and first generational, it should only get better.
Hi Jim, I'm pleased you have now responded to the recent PFA Post. I know you are personally interested in PFA and hoped you would share your thoughts re this research on the Forum, which you have now done. Thanks.
As you mention, and as I agreed, it's early days for PFA, and techniques will no doubt improve, especially if it's adopted in USA. I'm disappointed for you that it might not be available as soon as you seemingly had hoped.
Thanks Bob. In my case, I decided I didn't want to wait another year until PFA became available out of trial in the US, so I ended up doing a cryo PVI.
I should have digested your previous Replies better, and I would have known that. At the moment I "don't have a skin in the game" re ablations, but am always interested in your technical explanations of medical procedures and medications for Forum members. Such will apply to me one day.
Much appreciated. Keep it up. And may "the force of NSR" be with you.
PFA has already shown similar efficacy and safety to RF and Cryo and I would have no qualms about having it today. That said, it's still new and first generation and can should only get better if you can wait a bit.
I think all ablations are essentially killing off sections of the heart so that the rogue signals can't get through the scar tissue which is formed. Cryro, RF or Pulsed fields is just the method they use to kill off/burn the tissue.
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