Comparison between cryoballoon and hot balloon ablation in patients with paroxysmal atrial fibrillation

Suruga, Kazuki; Suenari, Kazuyoshi; Nakano, Takayuki; Takemoto, Hiroyuki; Hashimoto, Yuu; Tomomoi, Shunsuke; Higaki, Tadanao; Dai, Kazuoki; Oi, Kuniomi; Kawase, Tomoharu; Nakama, Yasuharu; Nishioka, Kenji; Otsuka, Masaya; Masaoka, Yoshiko; Shiode, Nobuo; Ito, Hiroshi

doi:10.1007/s10840-021-00978-0

Cited by 5 publications

(7 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Briefly, across the trials, three studies were RCTs ( 11 , 12 , 20 ), while the remaining studies were nonrandomized trials, including eleven prospective studies and six retrospective studies. Seven studies ( 9 , 13 , 16 , 17 , 23 , 25 , 26 ) compared HBA with CBA, eleven studies ( 10 – 12 , 15 , 18 – 20 , 22 , 24 , 27 , 28 ) compared LBA with CBA, and two studies ( 14 , 21 ) compared HBA, LBA and CBA simultaneously. Eight studies included only paroxysmal AF (PAF) patients, and the remaining 12 studies included both PAF and persistent AF (PerAF) patients.…”

Section: Resultsmentioning

confidence: 99%

“…Briefly, across the trials, three studies were RCTs (11,12,20), while the remaining studies were nonrandomized trials, including eleven prospective studies and six retrospective studies. Seven studies (9,13,16,17,23,25,26) and ROBINS-I tool (7). No significant publication bias was found by funnel plot or Egger's and Begg's tests based on the primary outcomes (Egger's: p = 0.312; Begg's: p = 0.976).…”

Section: Eligible Studies and Characteristicsmentioning

confidence: 89%

“…A previous study by Hojo et al showed that a balloon temperature of 73°C yielded a lower TUA rate than that at 70°C. The thickest anterior aspect of the left superior pulmonary vein (LSPV) was reported to be the dominant TUA area ( 13 , 23 ). However, a higher balloon temperature may increase the risk of PV stenosis; thus, additional TUA is still recommended for HBA ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Bayesian network meta-analysis comparing hot balloon, laser balloon and cryoballoon ablation as initial therapies for atrial fibrillation

Wu¹,

Hu²,

Kong³

et al. 2023

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

BackgroundBalloon-based catheter ablation (CA) technologies, including hot balloon ablation (HBA), laser balloon ablation (LBA) and cryoballoon ablation (CBA) have been introduced in recent years as alternatives to conventional radiofrequency ablation therapy for atrial fibrillation (AF). However, the results remain controversial concerning the optimal approach. Thus, we conducted a network meta-analysis (NMA) to comprehensively evaluate the efficacy and safety of HBA, LBA and CBA.MethodsClinical trials comparing the efficacy and safety of HBA, LBA and CBA were identified through a systematic search up to October 2022. The primary outcomes of interest were the recurrence of AF and procedure-related complications.ResultsTwenty clinical trials with a total of 1,995 patients were included in the meta-analysis. The NMA results demonstrated that HBA, LBA and CBA had comparable AF recurrence rates (HBA vs. CBA: odds ratio OR = 0.88, 95% credible interval CrI: 0.56–1.4; LBA vs. CBA: OR = 1.1, 95% CrI: 0.75–1.5; LBA vs. HBA: OR = 1.2, 95% CrI: 0.70–2.0) and procedure-related complications (HBA vs. CBA: OR = 0.93, 95% CrI: 0.46–2.3; LBA vs. CBA: OR = 1.1, 95% CrI: 0.63–2.1; LBA vs. HBA: OR = 1.2, 95% CrI: 0.44–2.8). The surface under the cumulative ranking curve (SUCRA) suggested that HBA may be the optimal approach concerning the primary outcomes (SUCRA = 74.4%; 61.1%, respectively). However, HBA (40.1%) had a significantly higher incidence of touch-up ablation (TUA) than LBA (8.5%, OR = 2.8, 95% CrI: 1.1–7.1) and CBA (11.9%, OR = 3.7, 95% CrI: 1.9–7.5). LBA required more procedure time than CBA [mean difference (MD = 32.0 min, 95% CrI: 19.0–45.0 min)] and HBA (MD = 26.0 min, 95% CrI: 5.6–45.0 min), but less fluoroscopy time than HBA (MD = −9.4 min, 95% CrI: −17.0–−2.4 min).ConclusionsHBA, LBA and CBA had comparable efficacy and safety as initial treatments for AF. HBA ranked highest in the primary outcomes, but at the cost of a higher incidence of TUA and longer fluoroscopy time.Systematic Review Registrationwww.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022381954, identifier: CRD42022381954.

show abstract

Section: Resultsmentioning

confidence: 99%

“…Briefly, across the trials, three studies were RCTs (11,12,20), while the remaining studies were nonrandomized trials, including eleven prospective studies and six retrospective studies. Seven studies (9,13,16,17,23,25,26) and ROBINS-I tool (7). No significant publication bias was found by funnel plot or Egger's and Begg's tests based on the primary outcomes (Egger's: p = 0.312; Begg's: p = 0.976).…”

Section: Eligible Studies and Characteristicsmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Bayesian network meta-analysis comparing hot balloon, laser balloon and cryoballoon ablation as initial therapies for atrial fibrillation

Wu¹,

Hu²,

Kong³

et al. 2023

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] More recently, novel energy sources and mapping algorithms have also been explored for AF catheter ablation. [27][28][29][30][31][32][33] Even with more sophisticated approaches, superior longterm effective treatment for AF above what is achievable with PVI alone has been a challenge. [34][35][36][37][38] However, could a key missing link lie outside the heart itself and be nestled within the nervous system?…”

mentioning

confidence: 99%

Ganglionic Plexus Ablation: A Step-by-step Guide for Electrophysiologists and Review of Modalities for Neuromodulation for the Management of Atrial Fibrillation

Aksu

Skeete

Huang

2023

Arrhythm Electrophysiol Rev

View full text Add to dashboard Cite

As the most common sustained arrhythmia, AF is a complex clinical entity which remains a difficult condition to durably treat in the majority of patients. Over the past few decades, the management of AF has focused mainly on pulmonary vein triggers for its initiation and perpetuation. It is well known that the autonomic nervous system (ANS) has a significant role in the milieu predisposing to the triggers, perpetuators and substrate for AF. Neuromodulation of ANS – ganglionated plexus ablation, vein of Marshall ethanol infusion, transcutaneous tragal stimulation, renal nerve denervation, stellate ganglion block and baroreceptor stimulation – constitute an emerging therapeutic approach for AF. The purpose of this review is to summarise and critically appraise the currently available evidence for neuromodulation modalities in AF.

show abstract

“…compared LBA with CBA, 40,41 2 compared PVAC with RFA, 42,43 1 compared HBA with CBA,44 and 1 compared HBA with AAD.…”

mentioning

confidence: 99%

Ablation therapies for paroxysmal atrial fibrillation: A systematic review and patient-level network meta-analysis

Fong

Zhao

Chan

et al. 2023

Ann Acad Med Singap

View full text Add to dashboard Cite

Introduction: Despite promising trials, catheter ablation is still regarded as an adjunct to antiarrhythmic drugs (AADs) in the treatment of paroxysmal atrial fibrillation (PAF). This study aimed to compare the effectiveness of various ablation therapies and AAD. Method: Randomised controlled trials or propensity score-matched studies comparing atrial tachyarrhythmia recurrence among any combination of ablation modalities or AAD were retrieved. Kaplan-Meier curves and risk tables for this outcome were graphically reconstructed to extract patient-level data. Frequentist network meta-analysis (NMA) using derived hazard ratios (HRs), as well as 2 restricted mean survival time (RMST) NMAs, were conducted. Treatment strategies were ranked using P-scores. Results: Across 24 studies comparing 6 ablation therapies (5,132 patients), Frequentist NMA-derived HRs of atrial fibrillation recurrence compared to AAD were 0.35 (95% confidence interval [CI]=0.25–0.48) for cryoballoon ablation (CBA), 0.34 (95% CI=0.25–0.47) for radiofrequency ablation (RFA), 0.14 (95% CI=0.07–0.30) for combined CBA and RFA, 0.20 (95% CI=0.10–0.41) for hot-balloon ablation, 0.43 (95% CI=0.15–1.26) for laser-balloon ablation (LBA), and 0.33 (95% CI=0.18–0.62) for pulmonary vein ablation catheter. RMST-based NMAs similarly showed significant benefit of all ablation therapies over AAD. The combination of CBA + RFA showed promising long-term superiority over CBA and RFA, while LBA showed favourable short-term efficacy. Conclusion: The advantage of ablation therapies over AAD in preventing atrial tachyarrhythmia recurrence suggests that ablation should be considered as the first-line treatment for PAF in patients fit for the procedure. The promising nature of several specific therapies warrants further trials to elicit their long-term efficacy and perform a cost-benefit analysis. Keywords: Atrial fibrillation, catheter ablation, network meta-analysis

show abstract

Comparison between cryoballoon and hot balloon ablation in patients with paroxysmal atrial fibrillation

Cited by 5 publications

References 22 publications

Bayesian network meta-analysis comparing hot balloon, laser balloon and cryoballoon ablation as initial therapies for atrial fibrillation

Bayesian network meta-analysis comparing hot balloon, laser balloon and cryoballoon ablation as initial therapies for atrial fibrillation

Ganglionic Plexus Ablation: A Step-by-step Guide for Electrophysiologists and Review of Modalities for Neuromodulation for the Management of Atrial Fibrillation

Ablation therapies for paroxysmal atrial fibrillation: A systematic review and patient-level network meta-analysis

Contact Info

Product

Resources

About