Evaluation of Isolation Area, Myocardial Injury and Left Atrial Function Following High-Power Short-Duration Radiofrequency or Second-Generation Cryoballoon Ablation for Atrial Fibrillation

Abstract

This randomized study aims to compare the left atrial (LA) lesion size, function, and tissue damage following pulmonary vein isolation (PVI) by high-power short-duration (HPSD) radiofrequency (RF) and second-generation cryoballoon (CB2) ablation. We enrolled 40 patients with paroxysmal atrial fibrillation who underwent PVI by HPSD RF (n = 21) or CB2 (n = 19). Every patient underwent LA CT angiography and transthoracic echocardiography (TTE) to assess the LA anatomy and function. Biomarker levels (hs-cTnT, hs-CRP, LDH) were compared pre- and post-procedurally. Pre- and post-ablation high-density mapping (HDM) was performed. The isolation area was defined under 0.2 mV bipolar voltage (low voltage area, LVA). We calculated the post-PVI LVA/LA surface ratio using LA CT-HDM merge images. At 3-month follow-up, TTE was performed to assess the changes in LA function. Post-ablation hs-cTnT level was significantly higher in the RF group (RF: 1249 ± 469 ng/L, CB2: 995 ± 280 ng/L, p = 0.024). Post-PVI hs-CRP (RF: 9.53 ± 10.30 mg/L, CB2: 12.36 ± 5.76 mg/L, p = 0.034) and LDH levels (RF: 349.9 ± 65.6 U/L, CB2: 451.6 ± 91.3 U/L, p < 0.001) were significantly higher following CB2 ablation. Post-PVI LVA/LA surface ratios were 8.37 ± 6.42% in the RF group and 13.58 ± 8.92% in the CB2 group (p = 0.022). LA function did not change significantly after the PVI procedure. Our data indicate that second-generation cryoballoon ablation produces a significantly larger LA lesion size compared to “point-by-point” HPSD radiofrequency. Both techniques preserve LA function. The myocardial component of tissue loss appears to be higher using HPSD radiofrequency ablation, with less collateral damage.

Meta‐analysis of high‐power short‐duration versus cryoballoon ablation for atrial fibrillation

“…A total of six articles, [16][17][18][19][20][21] comprising 2481 adult patients, were included in our meta-analysis as illustrated in Figure 1. Among these patients, 927 underwent HPSD while 1554 received CBA.…”

“…Among these patients, 927 underwent HPSD while 1554 received CBA. Out of the six studies, two were RCTs, 19,20 two were retrospective cohort studies, 16,18 one was a propensity-matched observational study, 21 and one consisted of both retrospective and prospective phases. 17 Baseline characteristics of the included trials are provided in Tables 1 and 2.…”

“…17 Baseline characteristics of the included trials are provided in Tables 1 and 2. Three studies specifically focused on patients with paroxysmal AF, [18][19][20] while the remaining studies encompassed a broader population of AF patients. Many participants had previously experienced treatment failure with antiarrhythmic drugs, and none had undergone prior AF ablation procedures.…”

“…16 The trials were conducted exclusively at single-center institutions, except for one study. 17 Three studies exclusively utilized contact force sensing catheters, [17][18][19] while the remaining three employed noncontact force sensing catheters. Only two studies were using very HPSD as a method of AF ablation, with one using 90 W 17 and one using 70 W. 16…”

“…There were three studies which only included paroxysmal AF, [18][19][20] one study which provided separate outcome data for patients with paroxysmal AF. 21 A total of 1225 patients from these four studies (631 in the HPSD and 594 in the CBA) were included in the subgroup analysis of paroxysmal AF.…”