Cryoballoon versus Radiofrequency Catheter Ablation in Atrial Fibrillation: A Meta‐Analysis

Cardoso, Rhanderson; Mendirichaga, Rodrigo; Fernandes, Gilson; Healy, Chris; Lambrakos, Litsa K.; Viles-González, Juan F.; Goldberger, Jeffrey J.; Mitrani, Raul D.

doi:10.1111/jce.13047

Cited by 93 publications

(62 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…the more complete and durable PVI that may lead to fewer AF recurrences, was not corroborated in this randomized trial, in the FreezeAF trial (8), or in any of the preceding observational studies (16). This may be due to several factors, some of which remain unknown.…”

mentioning

confidence: 62%

“…Thus, one could argue that the exclusive use of the second-generation cryoballoon and the contact-force sensing RF catheter could have led to different conclusions regarding the comparative effectiveness of the two interventions. Even though small observational studies have suggested that the second-generation cryoballoon and the contact-force sensing RF catheter may have similar long-term effects (16), results from a randomized comparison are lacking.…”

mentioning

confidence: 99%

See 1 more Smart Citation

FIRE or ICE for paroxysmal atrial fibrillation?—perspectives from the largest randomized evaluation of cryoballoon and radiofrequency ablation to date

Siontis¹,

Noseworthy

2017

J. Thorac. Dis.

View full text Add to dashboard Cite

For patients with symptomatic paroxysmal atrial fibrillation (PAF), radiofrequency (RF) catheter ablation is now a common procedure worldwide and its cornerstone is the point-by-point electrical isolation of the pulmonary veins (PVI) (1). While short-term symptom improvement is frequently the case after a single ablation procedure (2), the sustained success of the procedure depends largely on the completeness of the isolation. Most patients with recurrent arrhythmia have evidence of electrical reconnection between the PVI and the atrial tissue (3). Performing complete and lasting PVI requires meticulous point-by-point delivery of RF ablation which can be tedious and is prone to incomplete lesion sets. To overcome this limitation and improve the efficiency of the procedure, a balloon-based catheter technology was developed with which a single circumferential isolation lesion can be delivered to the pulmonary vein antra via a catheter-guided cryotherapy balloon. This approach showed promising results and favorable learning curves in early feasibility studies (4,5) and in the Sustained Treatment of Paroxysmal Atrial Fibrillation (STOP AF) trial, the first randomized comparison of cryoballoon ablation versus antiarrhythmic drug therapy (6).In STOP AF, all four PVs were successfully isolated in 97.6% of patients and 12-month freedom from recurrent arrhythmia was ~70%. Results of randomized comparisons with the control group being treated with conventional RF ablation emerged shortly thereafter. In the Cryo vs. RF trial, 237 patients were randomized to first-generation cryoballoon ablation, RF ablation, or a combination of the two (7). The 1-year success rate (freedom from atrial arrhythmia after single procedure) was significantly higher in the cryoballoon group compared to the RF group (67% vs. 47%, P<0.001), while the combined approach was not significantly better than cryoballoon ablation alone. In the FreezeAF trial of 315 patients with PAF, cryoballoon ablation was noninferior to RF and 6-month procedural success was about 63% for both groups after a single procedure (8).Following these encouraging early results, cryoballoon ablation begun being utilized as an alternative to RF ablation, while more definitive data on the comparative performance of the two techniques was awaited. Establishing such definitive evidence was the goal of the FIRE AND ICE trial (9) which was designed to address the question: is cryoballoon ablation non-inferior to the conventional point-by-point RF ablation in terms of efficacy and safety? A total of 762 patients with drug-refractory, symptomatic PAF from 16 centers in eight European countries were enrolled and 750 patients were randomized 1:1 to the two techniques between 2012 and 2015. None of the included patients had undergone a prior ablation procedure. Patients were followed at regular clinic visits and arrhythmia surveillance was performed with 24-hr ambulatory ECG at Editorial

show abstract

mentioning

confidence: 62%

mentioning

confidence: 99%

FIRE or ICE for paroxysmal atrial fibrillation?—perspectives from the largest randomized evaluation of cryoballoon and radiofrequency ablation to date

Siontis¹,

Noseworthy

2017

J. Thorac. Dis.

View full text Add to dashboard Cite

show abstract

“…In a recent meta-analysis including over 8000 patients with both paroxysmal and persistent AF, the overall freedom from atrial tachyarrhythmias at ≥12 months after radiofrequency ablation was 63%. This rate was not significantly different when compared to cryoballoon energy source (69.1%) [8]. In studies with long-term follow-up, AF recurrences have been reported in 50-70% of patients after a single ablation of paroxysmal and persistent AF, respectively [9,10].…”

Section: Catheter Ablationmentioning

confidence: 73%

“…Freedom from recurrent AF in follow-up greater than 1 year has been reported at 78% from pooled studies utilizing second-generation cryoballoon and contact-force sensing radio-frequency catheters [8]. On the other hand, targeting non-pulmonary vein triggers or substrate modification, including complex fractionated atrial electrograms and AF-sustaining rotors, have not consistently shown better outcomes as compared to PVI-alone, and thus are not recommended as routine AF ablation strategies.…”

Section: Catheter Ablationmentioning

confidence: 99%

See 1 more Smart Citation

Catheter ablation as first-line in atrial fibrillation: is rhythm control finally better than rate control?

Cardoso

Reddy

2017

Expert Review of Cardiovascular Therapy

Self Cite

View full text Add to dashboard Cite

Atrial fibrillation ablation in heart failure patients: improved systolic function after cryoballoon pulmonary vein isolation

et al. 2020

View full text Add to dashboard Cite

Aims Atrial fibrillation (AF) and heart failure (HF) are the most common cardiac diseases and often coexist leading to increased mortality and morbidity compared with AF patients without HF. As shown previously, AF ablation using radio frequency (RF) in HF patients leads to a reduction of AF burden, an increase of left ventricular ejection fraction (LVEF) and consequently to reduced hospitalization and mortality. Previous AF ablation studies on HF patients have been liberal about additional targets beyond pulmonary vein isolation (PVI). Thus, the aim of this study was to assess systematically the impact of a straightforward PVI-only strategy on LVEF, NYHA functional class, and cardiovascular hospitalization rate in HF patients. Methods and results Out of 414 consecutive patients undergoing PVI, only with the cryoballoon 113 patients with reduced LVEF [mean: 38.4 ± 10.8%, reduced ejection fraction (rEF) group] and 301 patients with normal LVEF (>55%) at baseline were identified [normal ejection fraction (nEF) group]. Remarkably, even though freedom from arrhythmia recurrence after 1 year was significantly lower in the rEF group (64.9%) compared with the nEF group (71.2%, P = 0.036), mean LVEF improved from 38.4 ± 10.8% to 52.5 ± 17.2% (P < 0.001) after cryoballoon ablation in the rEF group. Accordingly, HF-related symptoms as well as hospitalization rate declined significantly in the rEF group during follow-up compared with baseline. Conclusions The results of the present study suggest that catheter ablation restricted to a straightforward PVI-only strategy using the cryoballoon leads to improved left ventricular ejection fraction as well as improvement of NYHA functional class and increased freedom from cardiovascular rehospitalization.

show abstract

Cryoballoon versus Radiofrequency Catheter Ablation in Atrial Fibrillation: A Meta‐Analysis

Cited by 93 publications

References 39 publications

FIRE or ICE for paroxysmal atrial fibrillation?—perspectives from the largest randomized evaluation of cryoballoon and radiofrequency ablation to date

FIRE or ICE for paroxysmal atrial fibrillation?—perspectives from the largest randomized evaluation of cryoballoon and radiofrequency ablation to date

Catheter ablation as first-line in atrial fibrillation: is rhythm control finally better than rate control?

Atrial fibrillation ablation in heart failure patients: improved systolic function after cryoballoon pulmonary vein isolation

Contact Info

Product

Resources

About