Multi-catheter cryotherapy compared with radiofrequency ablation in long-standing persistent atrial fibrillation: a randomized clinical trial

Abstract

Aims Restoring sinus rhythm (SR) by ablation alone is an endpoint used in radiofrequency (RF) ablation for long-standing persistent atrial fibrillation (AF) but not with cryotherapy. The simultaneous use of two cryotherapy catheters can improve ablation efficiency; we compared this with RF ablation in chronic persistent AF aiming for termination to SR by ablation alone. Methods and results Consecutive patients undergoing their first ablation for persistent AF of >6 months duration were screened. A total of 100 participants were randomized 1:1 to multi-catheter cryotherapy or RF. For cryotherapy, a 28-mm Arctic Front Advance was used in tandem with focal cryoablation catheters. Open-irrigated, non-force sensing catheters were used in the RF group with a 3D mapping system. Pulmonary vein (PV) isolation and non-PV triggers were targeted. Participants were followed up at 6 and 12 months, then yearly. Acute PVI was achieved in all cases. More patients in the multi-catheter cryotherapy group were restored to SR by ablation alone, with a shorter procedure duration. Sinus rhythm continued to the last available follow-up in 16/49 patients (33%) in the multi-catheter at 3.0 ± 1.6 years post-ablation and in 12/50 patients (24%) in the RF group at 4.0 ± 1.2 years post-ablation. The yearly rate of arrhythmia recurrence was similar. Conclusion Multi-catheter cryotherapy can restore SR by ablation alone in more cases and more quickly than RF ablation. Long-term success is difficult to achieve by either methods and is similar with both.

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

“…Due to the difficulty of anticipating clinical incidence precisely, similar sample sizes have been applied to several clinical trials. 21 , 22 Although the interpretation of the data is limited, these findings still show the real outcomes of daily ablation practice and confirm the results of previous trials. Large-scale randomized clinical trials are demanded to further confirm the conclusions of this study.…”

Preventing esophageal complications from atrial fibrillation ablation: A review

“…Previous randomized study on multicatheter cryoablation showed that cryotherapy can be used to deliver linear lesions in the left atrium comparable to RF, but long-term outcomes were not significantly different, and so further study of this method using standard cryo-catheters was not recommended. 76 Ultra-low-temperature cryotherapy (Adagio Medical, Laguna Hills, CA) may change the limitations associated with standard cryotherapy. It is a novel and advanced form of cryotherapy that has begun its initial clinical evaluations.…”

“…Previous randomized study on multicatheter cryoablation showed that cryotherapy can be used to deliver linear lesions in the left atrium comparable to RF but long-term outcomes were not significantly different and so further study of this method using standard cryo-catheters was not recommended. 80 temperatures (down to -196 degrees Celsius), an esophageal warming balloon is used in the company's protocol for left atrial ablation work. The main published clinical evaluation using this technology so far, has been to treat atrial flutter.…”

Arrhythmias in Chronic Kidney Disease

“…Cryotherapy is comparable in efficacy to RF methods, but usually involves the use of contrast agents. [ 76 ] RF ablation without contrast and with meticulous control of arterial pressure is the preferred method.…”