Pulmonary vein

[Fishguy]

I had a cryo balloon ablation a year ago. Because of the vertical angulation of the right upper pulmonary vein it was impossible to isolate it with the cryo balloon. I have continued to have episodes of AF. I have an upcoming appointment and they will probably want to do radiofrequency on that vein. The doctor said he had not come across a vein in such a position before. Has anyone had or heard of a similar case ? Do you think this could be the cause of the AF.

[BobD Volunteer]

Lots of people do not have nice evenly positioned pulmonary viens which is why RF is commonly used to touch up . Some can even be conjoined so the balloon is unable to seal. Cryo is a useful relatively fast procedure often used as a first attempt but not infallible.

[mjames1 in reply to BobD]

Cryo is a useful relatively fast procedure often used as a first attempt but not infallible.

That may have been true from first generation Cryo. But the "fire and ice" trial conclusively showed that cryo- produces equal results to RF on an initial ablation. So it's no more or less "infallible" than RF.

Jim

[Fishguy in reply to BobD]

Thank you

[mjames1]

Yes, if they couldn't do a complete isolation that certainly could certainly be a reason why you're still having episodes.

I'm surprised they didn't do a chest CT in advance because if they had they would've known this and possibly switched to rf, or at least incorporated it in the same procedure with the cryo. The CT scsn prior is standard procedure at least in the United States and all Cryo ep's are versed in rf.

if you're not at a high-volume center, you might consider that for your next ablation as studies show results are better.

Jim

[Fishguy in reply to mjames1]

Thank you for your reply much appreciated

[JOY2THEWORLD49 in reply to Fishguy]

Hi

On Radcliffe UK Research Cryto... was said to be one of the most successive procedures for AF.

But there was a period where the balloons were recalled because they did not stay 'up'. Difficlt to visualise but that was the true story. Recalls are not good remember the silicone artificial breast saga where it leaked!

Life is full of successes and failures and AF ablations are just one of them that could affect us.

A friend who had an ablation finally, he was young like you. The procedure at the ready alerted the surgeon that he had two AFs operating in different places but at the same time. His was a catheter ablation. Well it must be 2 years now without a AF return.

But you say yours is now permanent/persistent. I thought that once p/p nothing would be successful.

You are like me and love eating fish.. Too much 'mercury' perhaps????

cherio JOY. 75. (NZ)

[Buffafly]

Yes, I have, but my first and only ablation was RF so it wasn’t a problem. My ablation was successful for about two years but hopefully yours will do better after the unusual vein has been treated.

[Fishguy in reply to Buffafly]

Thank you

[Ppiman]

From what I have read, one of the issues the doctor faces when inserting the catheter, with all of us, is individual anatomy. I have read that many different things are possible with changes in such as the shape of the heart, its position and its own blood supply. I gather some of us (myself included) have an oesophagus that presses tightly against the left atrium, putting it at risk from some forms of catheter ablation. Many apparently have an extra or one fewer pulmonary veins, and, as you have found the position is far from fixed.

Add to that that during the ablation, the doctor is relying on very indirect means indeed to see where theirs are and where he is going and, well, it doesn't surprise me the success rate is only around 70-80%.

Pulsed Field Ablation seems the way forwards, at least from a safety perspective.

Steve

[Fishguy in reply to Ppiman]

Thanks for your reply