4. “I’’ve heard of Cryo (freezing) catheters for PVA(I) ablations. Are they as good as or better than the RF (Radio Frequency) catheters for ablations?”
The FDA approved the first Cryo ablation balloon catheter for A-Fib in December 2010. According to a pioneer in the technique, Dr. Walter Kerwin of Cedars-Sinai-Los Angeles, Cryo ablation seems to have definite advantages over RF.
A Cryo ablation lesion can be tested before making it permanent; there is less risk of damaging other areas of the heart or esophagus; since Cryo does not ‘burn’, there is less risk of Stenosis (swelling or narrowing of the Pulmonary Vein opening); Cryo catheters stick to the heart tissue they touch helping avoid accidental slips of the catheter tip; Cryo produces no crust formations (as with RF burns) that can fall off and lodge in a blood vessel, perhaps causing a blood clot and stroke. (That’s one of the reasons blood thinners like heparin are used during RF ablations, to prevent these blood clots.) See: Dr. Kerwin’s explanation of Cryo Ablation.
In a 2008 research study in Germany using Cryo Ablation, 74% of Paroxysmal patients were free of A-Fib and in permanent sinus rhythm (similar to current cure rates for RF ablations for Paroxysmal A-Fib); the figure was much lower for those with persistent A-Fib—just 38%. The main complication reported was a temporary palsy of the phrenic nerve.
For more, see my article, A CryoAblation Primer
Editor’s Comments: CryoBalloon catheter ablation may be the answer to the problem of re-do’s. All too often RF ablation patients have to return for a second ablation, because of re-growth and reconduction of the RF ablated areas. The CryoBalloon catheter ablation may solve this problem because of its ability to easily and quickly produce uniform pulmonary vein isolation.
The CryoBalloon catheter may become a major improvement in the treatment of A-Fib. It has been used in Europe for some time, with close to 100% success rate in isolating the PVs, and 75%-80% success in keeping patients free of A-Fib without antiarrhythmic drugs.
The CryoBalloon Ablation is safer, but not that much safer than an RF catheter ablation—which is already a low risk procedure.
If we had a choice between the CryoBalloon and RF, we’d probably choose the CryoBalloon. But a RF ablation remains a good option with a high success rate and low complication rate.
Thanks to Jean Kirkland for suggesting this update.
Dr Walter Kerwin, Cardiac Electrophysiologist, website last accessed Feb. 15, 2013. URL: http://www.afibcryoablation.com/cryoablation.asp
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