My AF has suddenly become much more debilitating this year, and I’m on the NHS waiting list for an ablation at the JR in Oxford next spring. The EP gave me the choice between sedation and general anaesthetic, and because I’m very squeamish and frightened, I chose the latter. He didn’t talk to me at all about the pros and cons of each type of procedure, and I didn’t think to ask. But now I’m kicking myself, thinking I should instead have asked him which type of ablation he personally would recommend as best for me, and opt for that one. Is cryo under sedation better/safer than RF? If so, maybe I ought to ‘woman up’ and go for that. But how on earth do I weigh up the facts about both types of procedures? I haven’t been able to find any relevant fact sheets on the AF Association website. I’m sorry if this is a boring old chestnut to longer-serving members, but it’s all new and terrifying to me. I’ve always believed passionately in looking after myself and taking responsibility for my own health, but this is something that’s way out of my control now. I’d really appreciate your thoughts/advice
Ablation advice please: My AF has... - Atrial Fibrillati...
Ablation advice please
it isn’t a case of Cryo ablation with sedation or RF ablation with GA I have had RF ablations with both options.
Personally I recommend GA as you can be on the table for many hours. I did not tolerate sedation.
You still have time to ask questions but you must trust the EP to know what he is doing and make the appropriate decisions.
Pete
Thank you for your reply Pete. It’s very helpful
I think in general most people who have their first ablation have cryo, this is usually done under sedation although I have heard people on here say they had a general. I had a cryo for my first ablation, although it was uncomfortable it was manageable. You do what you feel is best for you, the only thing is that recovery time after the procedure is quicker under sedation. Easy said than done but try not to worry to much, look forward to the procedure and look forward to having no AF.
Some people including me may need a top up procedure and usually that is done by RF mine took less than an hour and I felt fine during the procedure. Also you can always change your mind on sedation or general but do what you think is best for you. All the best.
thanks so much for replying. I am a total wimp so maybe my instinct to go for a GA was the right one!
My first two RF ablations were done by sedation only and the 3rd with a GA. I far preferred being total out of it with the general anaesthetic.
Jean
Thanks Jean, much appreciated. I’m starting to think I probably made the right call.
Definitely agree Jean!
There is no" best". Each have benefits and downsides but I have never had an ablation without GA myself.
Cry beeing easier for the operator and quicker is usually used as a first attempt with RF available as a follow on but nothing is set in stone.
What Bob said really, but I had RF under sedation on my first one and only one so far, done in July this year at Barts in London. But I'm on a research program where they're following how the Americans do it to try and emulate their success levels. So maybe that's why they used RF? But I don't think that was anything to do with sedation or GA, as I had a choice and was told the waiting list was longer on GA. I was put on the list in April, only waited 3 months. Maybe, being on this program I was given priority? Don't know.
Thanks Bob, so helpful to hear from the ‘experts’. Am in the middle of a nasty AF episode right now, so am remembering why I do need this procedure done! It’s easy to forget between-times
If I understand you correctly, your ep gave you the choice between Cryo under sedation and RF under GA??
If it were me, I'd take Cryo under sedation, as long as your ep is ok with that. The reason is that both show identical efficacy per the "Fire and Ice Trial", however with sedation, you are not submitted to the potential side effects from GA, especially if you're older, not to mention being intubated with GA. The trade off is that you may be conscious to one degree or another and that can bother some people, although with the right protocols, additional sedation can be added if needed during the procedure, where you shouldn't feel anything or even be conscious. Something to discuss with your ep if you go this route.
Because in the US, they mostly use GA or a hybrid called MAC, I ended up using MAC for my Cryo. No tube down throat but the same agent was used as with GA and I had brain fog and felt tired for months afterwards. If I could have had true conscious sedation, that would have been my choice.
Jim
Thank you so much for your thoughtful reply. Yes, the EP’s line was they either do freezing with sedation (cryo I guess) or burning with GA (RF I’m surmising). And because I said I wanted a GA, I’m on the waiting list for Rf ablation. I think my biggest fear is/was of being conscious and in excruciating pain but not able to communicate this to the medics. I’ve read of this happening, though not for this particular procedure. But on the other hand I reacted really badly the only other time I had a GA for an operation two years ago, and was vomiting for 24 hours afterwards
I replied below but regarding communication particularly I was offered extra sedation whenever I so much as moved about a bit. They really did spoil me throughout. This was at Royal Papworth in Cambridge.
I had cryo the first time under sedation with no problems at all. The 2nd one was RF also under slight sedation . It was slightly uncomfortable but I just asked for more pain relief. It's not excruciating pain just a bit uncomfortable in your chest. I was knocked out after as I went I to AF again after 2nd ablation and was shocked back into NSR. I think the wait is longer should you require a GA.To be honest you don't really feel anything or see anything apart from the monitors which I found most interesting . I had both of mine at Broadgreen and highly recommend
I've had 2 ablations, both RF under GA. I think here in the US that GA is pretty much the norm, and I had no choice. Like you, I'd rather be out for the duration of the thing anyway. Good luck.. you will do well! Give yourself plenty of time to recover and heal afterward (especially the first one) and stay as positive as you can!
Thank you for your very kind reply Banquo - love the name, by the way
I’m sure much of this has already been said. There are no specific rules as such but generally, the first ablation offered is a Cryoablation under sedation. The reason being that it is effective for many, generally quicker than an RF ablation and does not necessarily require the patient to be absolutely motionless during the procedure and recovery tends to be much quicker. The benefit to the NHS is that more patients are treated more quickly and because results are not too dissimilar, this has a bigger impact on reducing the incredibly long waiting times. The reality often, but not always is that the patients actually have little choice in determining how the procedure is carried out. The hope and assumption is that the EP has determined what’s best for the patient and steers the patient accordingly on the basis they know what’s best. So when the patient turns up and decides they actually would prefer a GA is to sedation, they are told that no Anaesthetist is available so Hobson choice springs to mind! I’ve had both and although sedation for a Cryoablation could get uncomfortable, the EP reacted quickly to increase the knock out drops. Although the GA worked a dream, I did experience some quite unpleasant nausea for a short period but readily accepted that the benefits to the EP was worth it.
Thoughts and advice from me is go with the flow, don’t rock the boat as this could cause an unwanted cancellation. Generally, contrary to what some might say, EP’s tend to want to do the best for their patients. Best of luck and please let us know how you get on……
Thank you so much for your thoughtful reply. I don’t think I got around to thanking you yesterday- was in the middle of a very nasty AF episode. All over now 🤞
I had my ablation in July. Was very frightened too. I did not get an option to choose from but had Propofol sedation combined with several shots of Fentanyl and Midazolam. I tolerated everything well and was doing very well quickly after the procedure.
GA has several risks that are -as far as i understand- way more complicated than Propofol.
There is one thing to notice: People here talk about how they prefer to be "totally out". That is totally misleading. Sure, if you get propofol, you can wake up if you experience more intensive sensations. But you are not awake - you are far, far away. I did woke up once during the measurements and they immediately within 10 seconds put me under again. It was actually kind of fun. You are basically tripping all the way. Feeling great, no pain, no anxiety just relaxing. Never experienced something like that before.
I would always go for the sedation again. And talk about the anxiety, even if you climb on the table.
Best,
m, 37 yo
Thanks so much for replying. It’s all very helpful in building a picture. You’re so young to be having all this!
I think this varies. I was very definitely awake for both of mine. I watched the procedure on the monitor and spoke with the EP. Pain levels were monitored.
Unfortunately for me sedation was not as effective as you suggest. Not only was I on the table for many uncomfortable hours any “top ups” of the sedation drug had little or no effect. I was also awake when they carried out a cardioversion.
We are all so different and the main conclusion is that what suits one of us definitively doesn’t necessarily suit another.
Pete
I’ve been on waiting list in Exeter for over 12 months, I won’t have a choice, it’s sedation!
Nor me. I am under Glenfield in Leicester and told it's sedation
I’m told the outcome is supposedly better🤷🏻♀️ but I’ve got to AV node ablation!
I had an ablation under GA at glenfield plus others with sedation. You have to insist at Glenfield they will tell you the wait will be longer, but unless there’s a medical reason not to offer GA cost and staffing are not a valid reason
I don't really want a GA tbh
Hello 👋 I have had a cryo ablation under sedation, a RF ablation under sedation and a redo RF under general. All last year.
Your EP is best placed to discuss pros and cons with you and its not too late to ask but I'll share what I understand.
Cryo is often the first choice because it is better tolerated / less uncomfortable for people. It targets a larger area so covers more ground but/ and is less precise. It is usually the first procedure. They can do more in one day as it doesn't require general. And recovery is quicker.
All the procedures require an overnight stay. All have risks. Minimal but worth listening to and considering. My EP explained in detail.
RF is usually done under general. My first one wasn't as (apparently) I tolerated the cryo one so well they went for it without general.
This was so I could have it done sooner I think.
RF is usually done for the touch up or re do procedures as they are more precise and can target specific areas missed by cryo or where veins have reattached following cryo. This happens. A second procedure is often, not always, required.
Under general was much easier as obviously you wake up and it's all done but...though not a pleasant experience it is manageable under sedation and you are well monitored. Its not in their interests for you to be overly uncomfortable as you will move about and make their job harder.
Hope this helps. Do ask questions of your cardiologist, the arrhythmia nurses and EP. I found them all very knowledgeable, especially the EP.
No overnight stay after my Cryo under sedation, I went down at 9.30am and was home mid-afternoon.
Same here with little or no time to recovery back at work 2 days later
Hmmm not ideal by a long stretch. I hope you don't do manual labour! Would you say it's been a success despite your poor heart not being allowed the recovery time most people would say is vital to a favourable outcome?
Me neither. Out of Barts by tea time.
No overnight for my cryo. Arrived at 8am, discharged at9pm.
Can not help you with your query as I am like you, looking ahead maybe to the same situation. I live in Devon but if ablation was the way forward for me, I would like to opt to have it done in the JR if possible. What is the waiting time for ablation? Did they mention Pulse field ablation? Who is your EP b please? Be grateful for any info as may help my research. Like you I would choose GA, being a wimp I wouldn't trust myself to keep still. Wishing you well.
No, there has been no mention of pulse field ablation. I saw the EP at the end of July, and my provisional date for RF ablation is end of March. Pretty sure he said it would be sooner if I opted for the cryo/sedation combo, but I'm fairly happy with the wait - it gives me time to get my head round the idea.
I’ve had both cryo & rf. both under sedation. They hurt a fair bit But it was just about tolerable for me. Good luck.
I’ve had both sedation and GA always RF ablation. Personally I preferred the GA. When I had sedation I was worried I wouldn’t lay still enough and also concerned I would want the loo as the give you fluids throughout, to the extent that I got them to catheterise me. They can give you anti sickness medication, if this has been an issue in the past, which they did when I had a GA but not for sedation , I was very sick after sedation so it’s now noted to give me anti sickness regardless of method. Sometimes the wait is longer for your procedure if you opt for GA. The EP must think either is appropriate for you or wouldn’t have given you the choice.
I’ve had GA for both my RF ablations, the most recent also including fitting a CRT device. The EP didn’t go the ‘cryo route’, having decided before the first procedure that he would need to ‘spot ablate’. He knew this would be a long procedure and he needed me to be perfectly still to get the best results so recommended GA.
Iv had both. And I would choose GA any day.👍
I had a cryoablation two years ago. I had sedation and whilst I was fully conscious of what was going on, it was fine. I was probably on the table less than two hours. And to be honest the time flew by. I did not like the idea of a general anaesthetic Personal choice. Respect with the ablation. It changed my life. Like most people I was concerned before I went. When I got there, I was so relaxed and staff were so supportive.
Hi, I had a cryo ablation under sedation last week. I wasn't given a choice and know. If I had been I'd have gone for GA. However, I was really worried about it but the team were fantastic and even under conscious sedation, I remember very little, even the cardioversion at the end of the procedure. They did warn me about a few things that would cause discomfort and they did but it was all great and I was allowed home at 4pm. I'm pleased I did have it under sedation. I'm sure you will be fine too.
good luck with whatever you choose. I don’t think it is possible to decide “on the day”. With the team I am treated by, there is a much longer wait for GA. GA requires an overnight stay whereas in my hospital sedation meant you went home a few hours later, unless there were reasons to monitor you, or the procedure very late in the day. I did not find the sedation for cryo left me in pain. I was out with the fairies! I am old and crumbly but I really didn’t find the laying still or needing to pee a problem. The theatre was cold but they had a cupboard full of hot blankets, and someone held my hand and checked on me the whole time. I wouldn’t want the clinical stress on my body of a GA if I could avoid it. Three years later some break through episodes mean I am contemplating a touch up second one… the main thing was to take it easy for many days afterwards
I have had an RF and a Cryo under sedation. Recovery in an hour, home the same day. I had little pain from either ablation, the cryo in action is just like biting into a very cold ice cream on a hot day - the pain in in your head. The cryo stops, the pain stops. It only happens 4 times.I would not want a GE for this.
The RF is a bit more painful, and could be longer, but I have had worse at the dentist!
I've had one sedated, but uncomfortable at times, but quite interesting though sadly I couldn't see as much as I would have liked. Doted on by nurses throughout which is always lovely. Also had two by GA. They just put you to sleep and you wake up 4-6 hours later. For the longer ops they use GA, for short cryo they prefer sedation as it has less risks and you recover quicker. I was sitting up within an hour! Out of bed an hour after that.The sedation for cryo seemed very light as I think I remembered everything compared with sedation for the cardioversions and the trans- oesophageal ECG procedures where I remembered little to nothing. In fact after several of my cardioversions I had to ask if it had been done!!!!!
Hope this helps x
Hi, this site is really helpful, but I think those of us who use it tend to have on going problems so may not always be the best to give encouragement. So here's my twopenny worth.
I've had ablations and colonoscopies with sedation. I seem lucky that whatever they give me I don't feel or remember a thing. I was told when I asked about this that the drug they used with me was a version of Rohypnol, better know as the date rape drug as it wipes your memory so the whole ablation experience is not traumatic. Also my understanding is if you have GA you are more likely to need a night in hospital whereas sedation stops you driving but you can go home.
As for type of ablation I don't know what I've had I was told it was an ablation and at the time didn't know of any differences so just had what I was given. Its only after joining this site I found out there were different types. I assumed the docs knew what they were doing and left it to them. I've had 3 cardioversions before my first ablation and all worked for say 12-16mths, longer than my first 2 ablations, so they maybe something to consider if the waiting list is shorter.
Good luck
I went through the same thinking process (such as it is) and was mightily glad that I went for a general anaesthetic.
Although I don’t doubt there are a few extra risks with a GA, you do have a consultant anaesthesiologist looking after you and your vital signs whereas with a local anaesthetic, you don’t. And you awaken feeling groggy but fine!
Steve
All I can say is that at UHCW we have no choice. All ablation are sedation only.
Yes, my cryo at UHCW was under sedation and pretty light at that. I was aware all the way through up until they did a Cardioversion at the end, for which I was put right out.
It was uncomfortable at times, especially when the freezing happened, and they increased the sedation whenever I asked. Overall no worse than a visit to the dentist.
Apparently Prof Osman prefers to have the patient awake.
I believe there have been studies which indicate that multiple GAs can increase the risk of dementia and as I've quite a lot of GAs for other issues, it seemed a good choice to me
I’m so grateful to everyone who has taken the trouble to respond to my plea and shared their experiences of ablation. I’m gobsmacked TBH at receiving many kind and helpful responses. Thank you all so much. Your experiences are all so varied, and it’s really helping me to become better informed.
I had my ablation (cryo) under GA. I wasn’t given an option, but being a total fidget it was a wise call.
Don’t forget to tell them about your previous reaction to GA as they can ‘add a little something’ to the mix to help with post anaesthesia nausea/vomiting.
You should be OK. I wasn't given a choice in September 2022 so had sedation when I had the ablation. All good since. The procedure was uncomfortable but nothing to worry about. The consultant asked me if I minded listening to Dolly Parton whilst doing the procedure! I said fine so that was my experience - interesting!
I had a cryo ablation in May - under sedation - It was uncomfortable initially when they do the first vein, as you get an ice cream headache and yes, you know they are doing something, but not at all worrying and if you have had toothache ever, I would prefer the ablation.
I fell asleep and only woke up when they did the phrenic nerve stimulation.
I dot like GA's as I always feel like I've been hit by a bus and feel really sick, although the last one was in 1987
Hi. As you know, I had my first ablation in August this year. It was RF and under GA but at no time in the last 10 years did either of my cardiologists mention cryo or sedation. On the day, the anaesthetist told me he would be putting me under quite deeply as the EP didn't want me to move or even cough involuntarily while he was doing the zapping. I was glad to be out of it and don't think the GA hindered my recovery. Hope you get a date soon
I have had both sedation and GA. Ablation does take quite a time. Going for a 3rd Ablation soon. Ist one Lasted 3yrs of utter Bliss.❤️☺️. On the second one last May, they needed to pass a camera down for me, so it was definitely GA. Your message about JR. I lived in Thame when my boys were young. Happy Days. ☺️All the best
I had GA with my cryo. I'm like you,,,knock me out. ! Pay attention to your doctor and don't overdo. No lifting, driving etc, the first couple of days. My throat was tender for a few days..Nothing soup didn't cure😄 I would choose GA every time. Sore throat wins vs discomfort and the anxiety of being awake every time for me!
Hi
Hmm, I am from US. I have had 2 ablations. The 1st in 2021 and that lasted until April of 2023. I had the 2nd ablation 6-23. I was never given a choice of sedation. I had GA for both. I knew nothing about AF. I just thought the tiredness, almost fainting and running out of steam during teaching my dog training classes was just part of getting old since I am 71. What a life changing procedure having the ablation was. I was scared to death and took months for me to make the decision to have the 1st one. I almost canceled the day before but I got it together and went through with it. It was very little recovery and I felt great and ready to get back into my busy life. I was freaked out and disappointed when the symptoms came back two years later, but my Dr did explain at the start that it was a possibility that it might have to be repeated. I guess I wasn't dwelling on that so it hit me hard when the symptoms came back. Emotionally, it did not take me as long to schedule the second one since the 1st one let me go back to my normal life. I had both of mine by the same Dr at Duke in NC. I did a lot of research choosing the Dr. to make sure he was at the top of his field. I have never been happier. It was absolutely worth all the Dr. visits, heart monitor, EKGs, MRI's etc. I actually think all the pre tests were scarier than the ablation procedure day.
I wish you the best outcome possible.
Rory
Hi! Completely understand where you’re coming from!
I’m having my first one later this month-all being well!
I have opted for a general (Dt Barts in London) I don’t want to know anything about it and I’m queasy about having to swallow the camera beforehand as well!
I have read some medical papers on whether it’s better to ‘burn or freeze’ and if I’m given the choice I don’t know what I’ll say!
I’ll just explain that I would prefer to have the one which means I won’t have to come back here so often for other ones!! 😂😂
Knock on the woods ever since I was diagnosed never had any episodes. Mine happened every time I used each Chinese food they use msgm or what that is that affected my heart. Never ate their food again never encountered again even though I take my eliquis
Had cryo with sedation. It was uncomfortable rather than painful but the part they call "pacing" was not pleasant. You do have to lay quite still though, so if you're a fidget, GA may be best.
Had Pulsed Field ablation, with GA, felt great, day case out by 4.00pm.
Hi, general anaesthetic would be how I'd go too. I had mine in Dec 22 in Dublin under ga. Nsr since.
Had 2 RF for AFlutter - both under sedation. Trusted the EP (Lencioni - QE Brum) totally to choose most appropriate. I’m inquisitive and liked having some sense of what was going on - v interesting to observe from the slab! Besides, I understand there is a higher risk with GA, which I would regard as unnecessary for me personally to take. On first, at one point the burning was getting quite painful but I grinned and bared it but I did end up alerting the Dr. when it became quite severe and v uncomfortable - I felt the heat on every burn. They just gave me more sedative and off I drifted - no more pain but I did miss part of the procedure! Now I know how willing and easy it is for them to adjust the sedative, I would say earlier if I wanted less discomfort. You are in control - go sedative and enjoy the ride!
Btw - now waiting for 1st Ablation for AF. On cancellation list. Expecting RF under sedation.
2nd ablation 
