RF or Cryoablation?

During my appointment in March, EP mentioned Cryoablation would be suitable for me if I don't tolerate Flecainide well. I've been taking Flecainide 50mg BID for 8 weeks now, had one breakthrough incident last week on the plane when travelling to New Orleans, I was able to convert in 4 hours by taking an additional Flecainide and 25mg Metoprolol. With Flecainide I feel chest tightness very often and it really bothers. I am seeing my EP end of May and planning to discuss ablation with him.

My question is what would be a better choice, RF or Cryoablation? On FB some people commented Cryoablation don't last as long as RF, is this true? What method did you use for your treatment? thanks!

My understanding is cryo only treats the pulmonary veins. It that is where your problem is, wonderful! If not, you'll need RF to address the other areas. I have a local friend who had cryo many years ago and it is still durable.

Thanks for you reply George. I wonder how does EP determine where the troubled spots are?

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Yuxi
I wonder how does EP determine where the troubled spots are?

They use mapping catheters to find where other sources of afib are lurking. They use electrical stimulation and a drug (isoproterenol) to provoke those locations into revealing themselves. It's a highly skilled task that many average EPs haven't been trained for and haven't mastered. Cryo's only big selling points are it's fast and it's easy for relatively inexperienced EPs to use. RF in the hands of a skilled practitioner is superior in every other way. However, I don't know of any difference between the longevity of cryo and RF ablations. If the ablations lines are durable and in the right place, the longevity should be the same regardless of the technology used.

Everyone who follows this forum should know that they should never consider using a relatively inexperienced EP in the first place. I know that in many countries you can't choose your EP, and in some less developed countries you really don't have much choice, but if you can choose, choose the one with the most experience.

Thanks Carey for the explanation, it really helps. I will find out from my EP in next visit if he uses the mapping catheters and stimulation to pin point the location. He has been doing ablation for 20 years, I would think he’s got some experience. If his answer is no I should probably seek for a more experienced EP.

Ask him how many ablations he performs a month? He may have 20 years ablation experience (did they do ablations 20 years ago?) but perhaps he only does a few a month…not the volume an experienced higher elite EP may have done. Perhaps ask what % success rate of his patients after a year post first (index) ablation without drugs that he has achieved?

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susan.d
(did they do ablations 20 years ago?)

Yes. The first cardiac catheter ablation was performed in 1981. The procedure we know today as a PVI was developed by Michelle Haissaguerre in Bordeaux France in 1998.

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susan.d
Ask him how many ablations he performs a month? He may have 20 years ablation experience (did they do ablations 20 years ago?) but perhaps he only does a few a month…not the volume an experienced higher elite EP may have done. Perhaps ask what % success rate of his patients after a year post first (index) ablation without drugs that he has achieved?

Thanks Susan, these are good questions to ask

Hi Susan,
I remember reading one of your post that your cousin had a PFA trail with Dr. Reddy in Mount Sinai? How was her experience? Would you mind sharing? I would love to see Dr. Natale, but Dr. Reddy is much closer to me (I am in NJ). I looked online it seems he is also very experienced. I might see him if he still accepts candidate for PFA trial.

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Yuxi
Hi Susan,
I remember reading one of your post that your cousin had a PFA trail with Dr. Reddy in Mount Sinai? How was her experience? Would you mind sharing? I would love to see Dr. Natale, but Dr. Reddy is much closer to me (I am in NJ). I looked online it seems he is also very experienced. I might see him if he still accepts candidate for PFA trial.

It wasn’t my cousin (by marriage) although she does have Afib.

I had split the year between NY and CA, and Dr Halperin, my NY cardiologist at Mt Sinai, wanted me on the trial. It was during the pandemic so I was too scared to fly and I had it done locally instead. Dr Reddy was highly recommended. I’ll PM you his schedule person and you can look into it.

Haven’t posted for ages but had to jump in here…

Prof. Haïssaguerre did my ablation for long term persistent AF in January 2003, followed by a touch-up 3 days later because AF recurred. He thought it was going to be a gap in one of the lines but in fact it was a very toxic focus in the coronary sinus which was extremely difficult to find and ablate. I think a less skilled and experienced person would not have found it. At this time in UK only a couple of EPs were learning how to do a basic PVI and very few EPs in the world would even attempt ablation for long term persistent AF.

Sinus rhythm lasted 19 wonderful years! AF started again early in 2002 and Prof. Sabine Ernst and I are still dealing with it in London, UK.

Gill

Hope the best for you, Gill. 19 years was a great long relief.

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Gill
Haven’t posted for ages but had to jump in here…

Prof. Haïssaguerre did my ablation for long term persistent AF in January 2003, followed by a touch-up 3 days later because AF recurred. He thought it was going to be a gap in one of the lines but in fact it was a very toxic focus in the coronary sinus which was extremely difficult to find and ablate. I think a less skilled and experienced person would not have found it. At this time in UK only a couple of EPs were learning how to do a basic PVI and very few EPs in the world would even attempt ablation for long term persistent AF.

Sinus rhythm lasted 19 wonderful years! AF started again early in 2002 and Prof. Sabine Ernst and I are still dealing with it in London, UK.

Gill