Outcomes of cryoballoon or radiofrequency ablation in symptomatic paroxysmal or persistent atrial fibrillation

Abstract

Aims To evaluate the effectiveness and safety of cryoballoon ablation (CBA) compared with radiofrequency ablation (RFA) for symptomatic paroxysmal or drug-refractory persistent atrial fibrillation (AF). Methods and results Prospective cluster cohort study in experienced CBA and RFA centres. Primary endpoint was ‘atrial arrhythmia recurrence’, secondary endpoints were as follows: procedural results, safety, and clinical course. A total of 4189 patients were included: CBA 2329 (55.6%) and RFA 1860 (44.4%). Cryoballoon ablation population was younger, with fewer comorbidities. Procedure time was longer in the RFA group (P = 0.01). Radiation exposure was 2487 (CBA) and 1792 cGycm2 (RFA) (P < 0.001). Follow-up duration was 441 (CBA) and 511 days (RFA) (P < 0.0001). Primary endpoint occurred in 30.7% (CBA) and 39.4% patients (RFA) [adjusted hazard ratio (adjHR) 0.85, 95% confidence interval (CI) 0.70–1.04; P = 0.12). In paroxysmal AF, CBA resulted in a lower risk of recurrence (adjHR 0.80, 95% CI 0.64–0.99; P = 0.047). In persistent AF, the primary outcome was not different between groups. Major adverse cardiovascular and cerebrovascular event rates were 1.0% (CBA) and 2.8% (RFA) (adjHR 0.53, 95% CI 0.26–1.10; P = 0.088). Re-ablations (adjHR 0.46, 95% CI 0.34–0.61; P < 0.0001) and adverse events during follow-up (adjHR 0.64, 95% CI 0.48–0.88; P = 0.005) were less common after CBA. Higher rehospitalization rates with RFA were caused by re-ablations. Conclusions The primary endpoint did not differ between CBA and RFA. Cryoballoon ablation was completed rapidly; the radiation exposure was greater. Rehospitalization due to re-ablations and adverse events during follow-up were observed significantly less frequently after CBA than after RFA. Subgroup analysis suggested a lower risk of recurrence after CBA in paroxysmal AF. Trial Registration ClinicalTrials.gov (NCT01360008), https://clinicaltrials.gov/ct2/show/NCT01360008.

Conversion of atrial fibrillation to sinus rhythm during cryoballoon ablation: A favorable and not unusual phenomenon during second‐generation cryoballoon pulmonary vein isolation

“…The overall comparability of these two different techniques, after being addressed by the FIRE and ICE trial, 19 was recently confirmed by an observational cluster cohort study by Hoffmann et al, 23 who showed no difference between CB-A and RF ablation in terms of atrial arrhythmia recurrence and, furthermore, significantly less rehospitalization due to re-ablations and adverse events during follow-up after CB-A.…”

Cryoballoon versus radiofrequency ablation for persistent atrial fibrillation: a systematic review and meta‑analysis

“…In addition, the current analysis for repeat ablation revealed a possibly significant superiority of CBA over RFA after the sensitivity analysis accounted for heterogeneity. In the persistent AF subanalysis of the FREEZE Cohort Study, 19 repeat ablation was nearly halved with CBA as the persistent AF subanalysis including over 1000 patients showed a consistent and much higher (approximately 65%) success rate between the CBA and RFA groups. However, the duration of persistent AF history in this cohort study was less than 1 year, which is shorter than the duration of more than 2 years in most studies included in this meta -analysis.…”

“…In the recent FREEZE Cohort Study, 19 in which a second-or third -generation cryoballoon was used in 76% of patients undergoing CBA, a conference abstract 14 (FIGURE1). Two conference abstracts were excluded due to a suspicion of overlapping population.…”

“…The introduction of the second -generation cryoballoon reduced this application by half as compared with the first -generation cryoballoon. 19 Pulmonary vein anatomy might have no obvious influence on the outcome of cryoablation. 20 These findings might support the use of CBA for persistent AF.…”

Strategies to Improve the Outcome of Cryoballoon Ablation in the Treatment of Atrial Fibrillation

“…A meta-analysis that included 3,527 patients with PaAF and PeAF showed that the recurrence rates after CBA or RFCA was similar [7]. A prospective cluster cohort study that involved 4,189 patients showed that the recurrence rate of PeAF did not differ between CBA and RFCA during middle-term follow up [8]. A single-center large-scale study also found that the free survival rate for atrial arrhythmias was 78.6% after a single procedure for PaAF and 72.3% for PeAF at a median 39 months follow-up [9].…”