AVNRT: rf-- or cryoablation?

[boydboyd]

Three times in the last four years i have had a AVNRT, 220bpm which returned to a normal hartrate after being given adenosine at the hospital.I am a 37 year old male.
After consulting an cardiologist i had decided to do a rf-ablation.
I now recently read about cryoablation on the internet (cryocath.com), and the reduced chance of  a permanent AV-block during this procedure with cryoablation, due to the ability to test before doing the final ablation. I understand it is about 1% chance with rf-ablation. I' ve also read that the cryo-method has a higher recurrence rate.

I tend to feel that in my case reducing the chance of of having a permanent AV-block, even if its only 1%, is more important then the higher recurrence rate.

Is my understanding of the two methods correct? Can you say anything that can help me making the right choice?

Thank you very much for time,

Best Regards,
Boyd D

[CCF-M.D.-MJM]

Hi Boyd,

I did a quick google search of your question.  I found a cryoablation site that says it is a lower incidence of AV nodal problems.  Frankly, I don't have a lot of experience with cryoablation.  We do mostly RF ablations here and haven't experienced much AV block.

For you the most important thing is find an experienced operator who is comfortable using a single modality.  The last you want to do is ask someone who is used to doing RF ablations to switch and use cryoablation.  In my opinion I would prefer and experienced and comfortable physician rather than a specific technique.

I hope this helps answer your question.

[VikingColumbus]

Greetings boydboyd,

I too have had the 'runs'. Once Verapmil and twice Adenosine
were employed to put a rein on my heartbeat rpm which topped
202 as the highest caught on a strip. Prior to those events
the old 'suck in a load of air and bear down' technique had
worked for me. Find myself doing that from time to time, still.

Had/have to 'contend' with frequent tachy bursts of 5 to 12ish seconds prior to and still subsequent to taking Toprol XL100, for as my prescribing cardio put it, "taking the edge off' the inciting heart cells.

I'm on digoxin as well, to curb Afib episodes, and I'm inferring
it helps to slow things down as well as my tachys basically
seem to be slo-mo type now. Did I mention I have my share of
PVCs and PACs?

I too am interested in the option of ablation but as of now my
symptoms/distress from rhythm disturbances is tolerated. Good
fortune to you in your decision making on ablation.

VC

[WPWGuy]

Just out of curiosity, how do you know that you have AVNRT, as opposed to something else?

I did an rf ablation for leftsided accessory pathway which we found during EP study.  I think that the knowledge of having left sided accessory pathway versus AVNRT would have influenced my decision makeing about whether to have the ablation.

For instance, I would not be comfortable with ablation for AVNRT, especially if symptoms are infrequent, not severe, and can be treated with meds.  I would do the ablation for left sided pathway again, but would have to think about whether to allow use of transceptal or trans aorta approach to access it. Again, especially if symptoms are infrequent, not severe, or easily treated with meds.

Good luck.

[boydboyd]

Hello Vikingcolumbus and WPWGuy,

Thanks for your responses.

My cardio said that i have either AVNRT or an accessory pathway.
His approuch is to do the ablation right after the EP study.
I can also decide to not do the ablation when it turns out to be AVNRT.

When i get the "attacks", they were severe, did not go away, and i didnt even feel like driving to the hospital myself and had to call 911. vagus nerve stimulation or some other techniques didn't work. Medication can lower the chance of getting them again, but my cardio says there is a good chance they will "break through" the medication at one point.

Because of the high succesrate and small chance of comlications, I think i should go for it, whether its AVNRT or an accessory pathway.

WPWGuy, was your ablation succesfull? Did you experience symptoms tou did'nt have before, like PAC's?

Best Wishes,
Boyd

[WPWGuy]

I experienced SVT, 230+BPM for up to 6 minutes.  Few times a year, during exercise.  At EP, the doctor found accessory pathway on left wall of heart,  approached it through the aorta, and burned from inside the left ventricle. He had originally approached it from the left atria, but was unsuccessful there.

The SVT is now gone.  However, I do have short run atrial tachy,  and a very occasional short run of VT. I beleive that the short run VT is going away. I bbelieve the short run atrial tachy proabably is a result of left over tissue, or the result of unsuccessful operation there.

As it turns out, a third possible approach was for the doctor to approach the left wall by puncturing a hole in a membrane between left and right atria.  This might have eliminated the atrial tachy that I am now experiencing, as it gives better access to the left wall. But it carries some risks - such as puncturing the aorta.  So I am glad that we went down the aorta and through the bicuspid valve into the left ventricle, even though I have some questions now as to whether this approach may have been responsible for short run VT afterwards.

Your approach sounds good.  The study should leave you in a good position to understand your risks before jumping into an ablation. Hopefully things will turn out in your favor and you will be like I was --- with one of the easy problems to fix.  If not, and yours is AVNRT for instance, I suggest chosing a doctor wisely, understnding the facts, and making good use of second opinions.  Heart block is a big deal.

Good Luck.