Quality of life after the initial treatment of atrial fibrillation with cryoablation versus drug therapy

[www.heartrhythmjournal.com]

I don't get why anyone would go for cryo when there are better techniques are on offer. Do i have that wrong?
Anyway, that's what i told my EP who offered cryo. He said that the first option that is usually sufficient to stop AF is pulmonary cryo.
My take is that i want to reduce the chances of being poked with a massive probe twice.

I saw this thanksgiving weekend an EP on call at the hospital who told me he only does cryo—even with LAA, AV ablation and CS etc. I specifically asked if he meant only a hybrid ablation for the four veins and RF for the rest but he listed all the areas he ablated with cryo. It doesn’t overheat ones heart and need more saline to cool off the area I’m told.

It's confusing, isn't it?

Yep. Another EP told me with cryo there is less tissue damage because he lightly freezes the firing areas and if the patient is still in afib, he moves on to another spot and the tissue is thawed and viable. However if by lightly freezing a hotspot and the afib stops, he knows he got it and continues to freeze to produce scar tissue.

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susan.d
I saw this thanksgiving weekend an EP on call at the hospital who told me he only does cryo—even with LAA, AV ablation and CS etc. I specifically asked if he meant only a hybrid ablation for the four veins and RF for the rest but he listed all the areas he ablated with cryo. It doesn’t overheat ones heart and need more saline to cool off the area I’m told.

Sounds good until you consider the technology. He was simply rationalizing his inexperience. Cryo has one and only one option: Kill an entire circle of cells wherever you put the balloon, quite possibly with gaps because nothing in the human body is a perfect circle like a cryo balloon is. . You can't do one burn or two with cryo to achieve the desired result. You have to burn an entire circle every time. So if he's actually isolating tiny areas like the LAA with cryo (and I doubt he is), he's killing FAR more heart tissue than someone like Natale needs to with RF.

Cryo's only real benefit is it's faster and easier to learn, and it comes with some increased safety in junior hands. It's a good option for places where they can't afford to train EPs to top standards. It will stop afib in about 70% of patients even for a new EP's first 100 patients, but for the 30% it doesn't help, it's largely useless.