Cryoablation or radiofrequency ablation for Atrial Fibrillation: Which is better?

What’s better for ablation for Atrial Fibrillation (AF)? Freezing or burning? Cryoablation or Radiofrequency Ablation?

Atrial fibrillation is the most common heart rhythm abnormality affecting approximately 5% of the population is over 70 years of age. In certain situations, an atrial fibrillation ablation may be offered by your cardiologist.

This is often the case when you remain highly symptomatic and drugs have failed to control your symptoms adequately.

For more information about atrial fibrillation, please click here

What is cryoablation?

Cryoablation is a procedure using cooling technology to freeze the entrance to all for pulmonary veins sequentially using a balloon filled with pressurized nitrous oxide which freezes the lining of the pulmonary veins, effectively rendering these areas non-conductive to the electrical impulses that originate from the pulmonary veins and trigger AF, therefore isolating these veins.

This technique can be performed very easily, usually in under an hour by an experienced operator and results in similar success rates to the radiofrequency ablation approach. It is particularly
useful for patients with paroxysmal atrial fibrillation, but may also be recommended as a first line treatment for persistent AF too.

Medtronic’s Arctic Front Advance® Cardiac CryoAblation Catheter system

What is radiofrequency ablation?

Radiofrequency ablation uses heat energy which is generated by high-frequency vibrations which leads to disruption of the cardiac tissue surrounding the pulmonary veins, which also results in electrical isolation of the pulmonary veins, the endpoint of an AF ablation procedure.

Radiofrequency ablation is generally delivered through a cardiac catheter, which is easily manoeuvered into the heart before being applied.
In a point by point manner to achieve isolation of the pulmonary veins.

A radio-frequency catheter can also be used to successfully or other types of arrhythmia which may be arising from outside of the pulmonary veins, including atrial flutter, atrial tachycardia, and atrial ectopy.

Which is better: cryoablation or radiofrequency ablation?

Both cryoablation and radiofrequency ablation lead to the same and point: pulmonary vein isolation.

This is considered the most effective treatment for both paroxysmal and persistent atrial fibrillation.

Inexperienced operator’s hands, either of these approaches is reasonable first-line strategies for the treatment of atrial fibrillation when the pulmonary vein isolation approach is the endpoint target.

However, if you have other heart rhythm abnormalities in addition to atrial fibrillation, such as typical atrial flutter or atrial tachycardia, then a radio-frequency ablation approach is usually recommended as first-line treatment in order to be able to successfully treat the other rhythms previously seen.

Are the risks of Cryoablation and radiofrequency ablation for AF the same?

The risks of the procedure are very similar.

There is a 2 to 3% risk of groin hematoma, at 1% risk of a pericardial effusion (ie a small fluid collection around the heart), and are less than 0.5% risk of significant cardiac complications, for example, pericardial tamponade needing a drain or surgical intervention, stroke, heart attack,.

For cryoablation, there is a 1% risk of phrenic nerve damage which paralyzes is the diaphragm. This complication is rare and fully reversible with the recovery of the diaphragm function expected within six months.

So which approach is best?

Your cardiologist will normally discuss the options for AF ablation and given that both cryoablation and radiofrequency ablation have similar success rates with similar complication rates, the simplicity of an initial cryoablation approach together with the shorter duration of ablation in general for a cryoablation approach make this the ideal first-line treatment for paroxysmal atrial fibrillation.

To discuss your ablation strategy further with any electrophysiologist with expertise in both cryoablation and radiofrequency ablation guided by complex 3-D mapping systems, please get in touch with Dr. Lim