Ablation

Hi, I’m having an ablation next week in Port Charlotte, FL. I chose Dr Sydney Peykar since he trained in Boudreaux. I was expecting a RF ablation at consult, but he recommended a cryo ablation. He’s done over 5000 so hopefully competent. Since flecainide hasn’t kept me in NSR after 12/23/19 cardio version he wants to put me on Amiodarone for 3-6 months. I will try 3 months, but no longer.
Am I correct in assuming that if it necessary, a second one should be RF?
Any recommendations for an EP in Atlanta?
Thanks
Doug

I have heard that most (if not all) follow-up ablations are RF. Cryo can't get to some of the smaller problem areas and can only hit the main pulmonary vein. Therefore any follow-ups are done via RF. Someone can correct me if I'm wrong here. Generally speaking, cryo has no benefits over RF other than it's easier for the physician to perform. It has some disadvantages as well in that it lacks the aforementioned potential specificity of RF. If I were you, I'd ask a lot of questions before allowing a cryo procedure to be performed on me, even by an experienced EP.

Given my druthers I would prefer RF over cryo. If your only triggers were PV. And they new that going in then maybe. But they don't so RF IMHO is the better choice.

I was at an EP once and he told his staff to go home at 5pm and he was still blogged about himself and cryo saying the advantage was he would semi freeze a firing spot and if it didn’t stop the AF from firing he would then move in to another area and the area he semi freeze would thaw out without damage. He said cryo doesn’t destroy unnecessary heart cells/tissue with the semi freeze and thaw if it wasn’t the correct pathway.

I had a 2pm appointment and he was still blogging about himself until 6:30pm. I didn’t have him ablate me. He had a good sell tho...it was like going to a time share presentation but longer. He no longer does cryo...

Quote
rocketritch
Given my druthers I would prefer RF over cryo. If your only triggers were PV. And they new that going in then maybe. But they don't so RF IMHO is the better choice.

Agreed!
The EP i saw told me that the first ablation is cryo. So i asked him what if the triggers are away from the PVs? Didn't get a good answer. He just said that the majority of AF is triggered around the PVs.
This may be so but as a patient i'd like to avoid being 'worked on' twice when it could have been done with one intervention.

I've been told, for my first ablation, that they'll use the most appropriate type of catheter. They favour cryo because it's quicker. In many cases, it works fine.
The EP told me it wasn't always appropriate, depending on the patient's atrium. Cryo catheter has to be applied at the right angle to achieve good contact, which may sometimes bring problems.
The second EP, making a touch-up, saw that one of my PV was reconnected. He said it's common after a cryo.
It seems the common procedure with "easy cases" (most look easy until one discovers they're not) is to cryo ablate, which usually stops the afib. Nothing else is done. I don't know wether the EP should wait and insist trying to get more afib or checking for other ectopics. I'd say he should, but the first procedure is already heavy, with a lot of burns, so it might be really hard on the heart.
The couple of weeks after my cryoablation were likely the worst in my life. I don't really fear ablations, but they're brutal procedures.