What are the pros and cons of cyro ablation vs RF ablation for paroxysmal a fib.

[CFS56]

My husband is scheduled for cyro ablation 2/14.  I am seeing another EP (for myself, I also have a fib) and he was going to do an RF ablation.  Which one is better and safer?  Which has fewer complications?

[researcher09]

CF,  For paroxysmal either cryo or RF is up to the EP's preference.  The more experienced and skilled EPs prefer RF because the catheter is more flexible in terms of focal ablation if problematic triggering points are found outside of the pulmonary veins.  Whereas cryo is limited to PV isolation.  For paroxysmal, many can be cured by PV isolation.  It would be best if the EP is skilled (experience plus high volume) in RF even if he decides to use cryo initially.  If the AF has persisted for a while, RF is without doubt the better choice.  The newest catheters have real time contact force readout or floppy magnetically tipped catheter with constant contact force so major complication risks such as tamponade is much reduced.  Cryo biggest complication risk is phrenic nerve damage of around 7% most of which resolve over months but around 1% permanent.  The latter would reduce quality of life drastically.

[MichelleP_3811]

From my own research I believe that cryo may be slightly safer giving the EP more flexibility with tricky areas but I think that it possibly has less of a success rate or maybe more chance for recurrence but it has been a while since I researched them for my own svt ablation 5 years ago so things may have changed.  Afib ablations in general are trickier than reentry svts ablations and recurrence can happen especially if the afib is caused by heart damage or afib that has been present for a long time.  From what I understand it is better to treat it sooner rather than later if it appears to be more than a passing occurrence.  I think it would be a good question to bring up with the EP.  Best of luck to both you and your husband.