A systematic review and meta‐analysis comparing second‐generation cryoballoon and contact force radiofrequency ablation for initial ablation of paroxysmal and persistent atrial fibrillation

Abstract

Introduction: Cryoballoon ablation (CBA) and radiofrequency ablation (RFA) are the preferred modalities for catheter ablation of atrial fibrillation (AF). Technological advances have improved procedural outcomes, warranting an updated comparison. We sought to evaluate the efficacy and safety of CBA-2nd generation (CBA-2G) in comparison to RFA-contact force (RFA-CF) in patients with AF. Methods: MEDLINE, Cochrane, and ClinicalTrials.gov databases were searched until 03/01/2020 for relevant studies comparing CBA-2G versus RFA-CF in patients undergoing initial catheter ablation for AF. Results: A total of 17 studies, involving 11 793 patients were included. There was no difference between the two groups in the outcomes of freedom from atrial arrhythmia (p = .67) and total procedural complications (p = .65). There was a higher incidence of phrenic nerve palsy in CBA-2G (odds ratio: 10.7; 95% confidence interval [CI]: 5.85 to 19.55; p < .001). Procedure duration was shorter (mean difference: −31.32 min; 95% CI: −40.73 to −21.92; p < .001) and fluoroscopy duration was longer (+3.21 min; 95% CI: 1.09 to 5.33; p = .003) in CBA-2G compared to RFA-CF. In the subgroup analyses of patients with persistent AF and >1 freeze lesion delivered per vein, there was no difference in freedom from atrial arrhythmia. Conclusions: In AF patients undergoing initial ablation, CBA-2G and RFA-CF were equally efficacious. The procedure duration was shorter, but with a higher incidence of phrenic nerve palsy in CBA-2G. In patients with persistent AF, there was no difference in the efficacy between CBA-2G or RFA-CF techniques.

A Systematic Review and Meta-Analysis of the Direct Comparison of Second-Generation Cryoballoon Ablation and Contact Force-Sensing Radiofrequency Ablation in Patients with Paroxysmal Atrial Fibrillation

“…However, the study included patients with non-paroxysmal AF in the final analysis. A meta-analysis from Ravi et al, [64] which included RCT and cohort studies comparing CF-RF ablation and 2G-CB ablation, revealed that the efficacy between both groups was similar. Another meta-analysis from Wang et al [65] that included RCTs showed that AF recurrence rates between both ablation strategies were comparable.…”

Effectiveness of Radiofrequency Catheter Ablation Using Ablation Index Versus Second Generation Cryoballoon in the Treatment of Persistent Atrial Fibrillation: A Matching-Adjusted Indirect Comparison

“…Contemporary meta-analytic studies have sought to assess the comparative efficacy of RF and CB ablation for AF [21][22][23]; however, these analyses included mixed AF types and/or generations of ablation technologies, precluding comparison of the latest generations of RF and CB technologies available for the treatment of PsAF. A meta-analysis by Liu and colleagues [23] is the first to compare the efficacy and safety of cryoablation and RF ablation in PsAF ablation.…”

Cryoballoon pulmonary vein isolation as a standard approach for interventional treatment of atrial fibrillation. A review and a practical guide to an effective and safe procedure

“…Electrical isolation of the left inferior pulmonary vein was diagnosed by observation of an exit blockthere was a spontaneous slow electrical activity in the pulmonary vein (Las2 -Las4) that was dissociated from the regular electrical atrial activity and the sinus rhythm, evident in the coronary sinus recordings (CS1-CS2) and the surface ECG leads (III, aVR, aVF, V1), respectively persistent, LA size and the presence of heart failure [15,16]. Patients with persistent AF have a poorer long-term outcome than patients with paroxysmal AF -55-72% vs. 75-81% respectively [15,17,18]. Patients with heart failure probably have the greatest survival benefit from AF ablation (CASTLE-AF trial) despite the significantly lower AF-free survival after ablation than patients with preserved left ventricular function [19][20][21][22].…”

“…The AF-free survival rate significantly depends on the clinical characteristics of the studied group and the presence of risk factors, especially the type of AF – paroxysmal vs. persistent, LA size and the presence of heart failure [ 15 , 16 ]. Patients with persistent AF have a poorer long-term outcome than patients with paroxysmal AF – 55–72% vs. 75–81% respectively [ 15 , 17 , 18 ]. Patients with heart failure probably have the greatest survival benefit from AF ablation (CASTLE-AF trial) despite the significantly lower AF-free survival after ablation than patients with preserved left ventricular function [ 19 – 22 ].…”