"This book is incredibly complete and easy-to-understand for anybody. I certainly recommend it for patients who want to know more about atrial fibrillation than what they will learn from doctors...."

Pierre Jaïs, M.D. Professor of Cardiology, Haut-Lévêque Hospital, Bordeaux, France

"Dear Steve, I saw a patient this morning with your book [in hand] and highlights throughout. She loves it and finds it very useful to help her in dealing with atrial fibrillation."

Dr. Wilber Su Cavanaugh Heart Center, Phoenix, AZ

"Your book [Beat Your A-Fib] is the quintessential most important guide not only for the individual experiencing atrial fibrillation and his family, but also for primary physicians, and cardiologists."

Jane-Alexandra Krehbiel, nurse, blogger and author "Rational Preparedness: A Primer to Preparedness"


"Steve Ryan's summaries of the Boston A-Fib Symposium are terrific. Steve has the ability to synthesize and communicate accurately in clear and simple terms the essence of complex subjects. This is an exceptional skill and a great service to patients with atrial fibrillation."

Dr. Jeremy Ruskin of Mass. General Hospital and Harvard Medical School

"I love your [A-fib.com] website, Patti and Steve! An excellent resource for anybody seeking credible science on atrial fibrillation plus compelling real-life stories from others living with A-Fib. Congratulations…"

Carolyn Thomas, blogger and heart attack survivor; MyHeartSisters.org

"Steve, your website was so helpful. Thank you! After two ablations I am now A-fib free. You are a great help to a lot of people, keep up the good work."

Terry Traver, former A-Fib patient

"If you want to do some research on AF go to A-Fib.com by Steve Ryan, this site was a big help to me, and helped me be free of AF."

Roy Salmon Patient, A-Fib Free; pacemakerclub.com, Sept. 2013

CryoBalloon Ablation: Alarming O.R. Reports (Part I)

A two-part series by Steve S. Ryan, PhD

Often when A-Fib patients contact me, I’ll advise getting a copy of their O.R. (Operating Room) report so I can read exactly what was done during their ablation. The details in an O. R. report can be quite revealing and usually reassure me that their EP did a good job.

An O.R. report of a catheter ablation is a blow-by-blow account of your EP’s actions.

But sometimes the report is disappointing. I just read two O.R. reports of CryoBalloon ablations that left me alarmed and disturbed.

O.R. Report #1: Ablation Without Identifying the Source of A-Fib Signals

The first CryoBalloon ablation was performed at one of the most prestigious A-Fib centers in New York City.

At the beginning of the ablation, it appears the Electrophysiologist (EP) made no attempt to first map the source of the patient’s A-Fib signals (mapping at the beginning or before hand is standard procedure at most A-Fib centers).

During the ablation the EP did not check for non-PV triggers or even attempt to identify the source of her A-Fib signals or potentials. The EP merely ablated the pulmonary veins (PVs), but did check for entrance and exit block.

At the beginning of the CryoBalloon ablation, the EP made no attempt to first map the source of the patient’s A-Fib signals.

At the end of the CryoBalloon ablation, he did not verify all A-Fib signals had been terminated by trying to trigger A-Fib with pacing or drugs like isoproterenol. (Triggering A-Fib means a new round of A-Fib isolation.) Once again, this verifying step is standard protocol for most ablations at most centers.

Result: the CryoBalloon ablation appeared to successfully isolate the patient’s PVs, and luckily she seems to be doing well.

My Observations

What’s alarming is what the EP didn’t do! This CryoBalloon ablation was less than the standard.

The very minimum steps were taken: isolate the Pulmonary Veins and little more. There was no effort to check for non-PV sources of A-Fib signals. No verification that all A-Fib sources were terminated. In fact, this patient may still have spots producing A-Fib signals.

Why go through an ablation if the EP didn’t do a thorough job? If the patient’s A-Fib returns, a second ablation may be required.

Now you know why I was disturbed by this O. R. report. Now, let’s look at the second report.

O.R Report #2: Non-PV Triggers Still Causing A-Fib

I read another O.R. report of a CryoBalloon Ablation on a patient who was in persistent A-Fib for two months before the ablation.

After isolating the PVs, the patient remained in A-Fib.

After isolating the PVs, the patient remained in A-Fib…the EP simply electrocardioverted the patient back into normal sinus rhythm.

Instead of looking for and ablating the source of these non-PV triggers, the EP simply electrocardioverted the patient back into normal sinus rhythm. (That’s certainly faster and easier than looking for non-PV triggers.)

Result: The patient was back in A-Fib within a month.


According to the patient, when the patient and his family first met with the CryoBalloon ablationist, they asked the right questions:

“What will you do if I still have A-Fib after the ablation?”

The EP said he would not stop until all the A-Fib spots were found and ablated.

In reality, instead of doing that, he just electrocardioverted the patient back into normal sinus rhythm without looking for and ablating the patient’s still-firing non-PV triggers.

It’s no wonder the patient was back in A-Fib shortly after this ablation.

Again, I was alarmed and troubled by what I read.

Take Away: O. R. Reports

An O.R. report is a blow-by-blow account of your EP’s actions. Indeed, the details in an O. R. report can be quite revealing. In these two cases, alarmingly so.

Read our free report.

Read our free report.

If you’ve had an ablation that was less than successful, you want to know why! Your O.R. report would show what they found in your heart, what was done, and possibly why the ablation didn’t fulfill expectations.

Read more about O. R. reports in our Special Report How & Why to Read Your Operating Room Report

NEXT TIME, IN PART II: Is Performing CryoBalloon Ablations too Easy?

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