Ablation

Does anyone know of any studies comparing RF Ablation with Cryo Ablation?

Peter,

I have not personally read any studies on cyroablation but have read about it being used as a possible replacement for RF in the future. I did talk to Dr. Tchou, personally about it at the Cleveland Clinic Foundation and he told me that it does look promising. Because of the techniques used wty the Cryo, there is almost no chance of stenosis occuring with the pulmanary veins..This sounds promising. But the catch was that they will not be using them on humans, for another two years......at least in the USA....Also I gleaned from that conversation that most of the research is being focused to the cyro and away from the ultrasound, which has done miserably in tests on animals...Due to inability to get up enough power to actually ablate..

Joe

They have done cryo ablations in Canada in the city of London. They looked good initially but after a period of weeks the afib returned. I believe they will be trying a new catheter in the 2nd quarter of 2004.

So currently I beleive RF is superior to cryo although the stenosis risk is lower with cryo.

Cleveland clinic is using an ultrasound tool that improves the accuracy of the RF lesions and seems to be greatly reducing RF stenosis problems. We have this tool in London but apparently it is mainly used for research due to the cost of operation. Money rears its ugly head again.

keith

I read an article a while ago about a Canandian company that manufactures the cryo probe. I listened to the conference call
and they reported that the probe was used to perform ablations
in Germany and that no stenosis was reported along with a respectable
success rate in eliminating Afib. A little search on the internet will reveal
the company name and you can get the name of the hospitals using the probe. I believe two centers are currently using the probe.

Kieth,
The cath you are talking about is called the ICE catheter (Inter Cardiac Echo) and is leaps and bounds above the TEE (Trans esophagal echo) which is still used by many places. I would not have an ablation done, unless the were using the ICE catheter It has remarkably improved the accuracy of the placement of the lasso catheters and allows the doctors to see a much better real time visual of what is happening.

Joe

That is exactly what happened to me.

I was part of the cryo clinical trial in Ottawa, Canada in 2001. 3 days after the ablation I had a couple of hours of PAC's but apart from that NSR for 3 weeks, then, during a moment of stress, the Afib returned and was pretty much as before the abaltion. My EP and I concluded that the lesions healed,

The catheters are made by Cryocath (www.cryocath.com).

I recently saw a report that one of their older catheters had sprung a leak during the procedure and released some coolant into the patient. The patient recovered. This report was in a financial paper and so concentrated more on the effect on share prices than anything else.

A second advantage of cryo is that the heart muscle is 'deactivated' before it is irreversibly damaged. The muscle can be frozen, the affect on the heart checked and then thawed if it is not the right place. This is probably more relevant for focal point ablations than for PVI.

The other issue with cryo is that it takes longer. Creating a lesion with RF takes about 2 minutes, with cryo it takes about 5 minutes. A full PVI requires a lot of lesions and so the time difference is significant.

The technique is still being developed and may yet replace RF.

Chris P

The company that is the current leader in Cryo-Ablation appears to be Cryo-Cor located in San Diego. While the US is very cautions about the procedure at this time, a lot of Cryo ablations have been done in Masstricht in the Netherlands using the Cryo- Cor equipment. The story is very compelling and the success rate is very high. The only negative seems to be the length of time for the procedure which I am told can be up to 5 hours. If anyone has any more info, I would appreciate hearing about it as I am seriously considering having the procedure next March.