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Considering a CryoBalloon Ablation? Seek an EP also Skilled in RF Ablation Techniques

Recently a patient, still in A-Fib after a CryoBalloon ablation, sent me their Operating Room (O.R.) report which is a blow-by-blow account of the EP’s actions during the procedure.

In my review of their report, after cryoablation of the Pulmonary Veins (PV), the patient was still in A-Fib. It appears the EP did not to make any attempt to map and isolate non-PV triggers. Instead the EP simply electrocardioverted the patient to return him to normal sinus rhythm (NSR). This may work in some cases, but for this patient the ablation was a failure. 

Your O.R. report is a historical record of the EP’s actions during your ablation.

When Considering a CryoBalloon Ablation

When selecting your electrophysiologist (EP), be cautious. For the best results, you want an EP who is not only experienced with CryoBalloon, but also, when needed, can use RF to map and isolate non-PV triggers.

Stay away from EPs who only do CryoBalloon ablation. Some EPs with little or no expertise with RF catheter ablations are now doing CryoBalloon ablations because they’re easier (i.e. less demanding) and faster to perform (more lucrative).

Seek an EP with Both Sets of Skills

Dr-Ali-Sovari, EP Lab, Oxnard, CA at

Dr Ali Sovari and nurse, EP Lab, Oxnard, CA (procedure observed and photographed by Steve Ryan)

A dual skill-set approach is supported by a study of about 75 paroxysmal A-Fib patients undergoing their first CryoBalloon ablation. Researchers found about 30% of patients required the additional use of RF focal lesions to achieve isolation (to restore normal sinus rhythm).

Most RF-experienced EPs who are now doing CryoBalloon ablations, have the ability and skill to use focal point RF techniques, as needed, to make you A-Fib free during your CryoBalloon ablation.

What Patients Need to Know

In the patient’s case above, an EP experienced in mapping and making RF lesions, could have used these additional skills and tools to locate and ablate non-PV sources of A-Fib signals, and hopefully return the patient to normal sinus rhythm (NSR) at the conclusion to the ablation.

To find the right electrophysiologist (EP) for your CryoBalloon ablation, seek out RF-experienced EPs by asking these probing questions:

 “What do you do if I’m still in A-Fib after you do the CryoBalloon ablation? Will you use RF focal lesions to achieve isolation?”

To learn more about these research findings see By Combining RF and CryoBalloon Ablation Techniques, Do Success Rates Increase?

Reference for this article
Hunter, Ross. Cryoballoon faster and more effective than conventional radiofrequency ablation for paroxysmal AF. Cardiac Rhythm News. Wednesday, May 14, 2014.—latest-news/cryoballoon-faster-and-more-effective-than-conventional-radiofrequency-ablation-for-paroxysmal-af

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