Cryoballoon vs. radiofrequency catheter ablation: insights from NOrwegian randomized study of PERSistent Atrial Fibrillation (NO-PERSAF study)

Abstract

Aims Pulmonary vein isolation (PVI) is still regarded as a cornerstone for treatment of persistent atrial fibrillation (AF). This study evaluated the effectiveness of PVI performed with cryoballoon ablation (CBA) in comparison with radiofrequency ablation (RFA) in patients with persistent AF. Methods and results A total of 101 patients with symptomatic persistent AF were enrolled and randomized (1:1) to CBA or RFA groups and followed up for 12 months. The primary endpoint was any documented recurrent atrial tachyarrhythmia (ATA) lasting longer than 30 s following a 3-month blanking period. Secondary endpoints were procedure-related complications, procedure and ablation duration, and fluoroscopy time. The ATA-free survival curves were estimated by Kaplan–Meier method and analysed by the log-rank test. According to intention-to-treat analysis, freedom from ATA was achieved in 36 out of 52 patients in the CBA group and 30 out of 49 patients in the RFA group (69.2% vs. 61.2%, P = 0.393). No difference in AF recurrence was found between the two groups (27.5% in CBA vs. 38.0% in RFA, P = 0.258), and less atrial flutter recurrence was documented in the CBA group compared with the RFA group (3.9% vs. 18.0%, P = 0.020). The procedure and ablation duration were significantly shorter in the CBA group (160 ± 31 vs. 197 ± 38 min, P < 0.0001; 36.7 ± 9.5 vs. 55.3 ± 16.7 min, P < 0.0001). There was no difference regarding fluoroscopy time (21.5 ± 7.8 vs. 23.4 ± 11.2 min, P > 0.05). Conclusion Compared with RFA, PVI performed by CBA led to shorter procedure and ablation duration, with less atrial flutter recurrence and similar freedom from ATA at 12-month follow-up.

Catheter Ablation vs. Medical Therapy as First-line for Treatment of Symptomatic Paroxysmal Atrial Fibrillation: A Systematic Review

“…Both radiofrequency ablation (RFA) and cryoballoon ablation (CBA) are considered safe options for the treatment of AF [22,23]. The underlying triggers for paroxysmal AF are assumed to originate in the pulmonary and thoracic veins [24,25].…”

Left atrial appendage occlusion combined with cryoballoon or radiofrequency ablation: One-year follow-up comparison

“…Radiofrequency ablation (RFA) and cryoballoon ablation (CBA) are the two most commonly used catheter ablation methods in clinical practice. The performance of RFA and CBA in paroxysmal AF and persistent AF has been confirmed by a large number of trials: CBA is not inferior to RFA in terms of AF recurrence and AF burden; the risk of SAEs is similar between the two methods; and procedure and ablation times are significantly shorter for CBA than RFA (10)(11)(12). The majority of studies have evaluated the safety and efficacy of RFA combined with LAAO, but only a few studies have focused on the clinical efficacy of CBA combined with LAAO (13)(14)(15)(16)(17)(18)(19).…”

Thawing plateau time indicating the duration of phase transition from ice to water is the strongest predictor for long-term durable pulmonary vein isolation after cryoballoon ablation for atrial fibrillation—Data from the index and repeat procedures

“…All patients were treated with an irrigated radiofrequency ablation catheter with the aid of a 3-dimensional mapping system (EnSite NavX, Abbott, or Carto 3, Biosense Webster, Inc). Procedural details were published ( 14 ) earlier. All PVs were checked and reconnection was verified by the recording of the PV potentials.…”