Procedure characteristics and outcomes of atrial fibrillation ablation procedures using cryoballoon versus radiofrequency ablation: A report from the GWTG‐AFIB registry

Abstract

Introduction Cryoballoon ablation (CBA) is an alternative to radiofrequency ablation (RFA) for ablation of atrial fibrillation (AF) and real‐world comparisons of this strategy are lacking. As such, we sought to compare patient and periprocedural characteristics and outcomes of CBA versus RFA in the Get With the Guidelines AFIB Registry. Methods Categorical variables were compared via the χ2 test and continuous variables were compared via the Wilcoxon rank‐sum test. Adjusted analyses were performed using overlap weighting of propensity scores. Results A total of 5247 (1465 CBA, 3782 RFA) ablation procedures were reported from 33 sites. Those undergoing CBA more often had paroxysmal AF (60.0% vs. 48.8%) and no prior AF ablation (87.5% vs. 73.8%). CHA2DS2‐VASc scores were similar. Among de novo ablations, most ablations involved intracardiac echocardiography and electroanatomic mapping, but both were less common with CBA (87.3% vs. 93.9%, p < .0001, and 87.7% vs. 94.6%, p < .0001, respectively). CBA was associated with shorter procedures (129 vs. 179 min, p < .0001), increased fluoroscopy use (19 vs. 11 min, p < .0001), and similar ablation times (27 vs. 35 min, p = .15). Nonpulmonary vein ablation was common with CBA: roof line 38.6%, floor line 20.4%, cavotricuspid isthmus 27.7%. RFA was associated with more total complications compared to CBA (5.4% vs. 2.3%, p < .0001), due to more volume overload and “other” events, although phrenic nerve injury was more common with CBA (0.9% vs 0.1%, p = .0001). In the adjusted model, any complication was less common among CBA cases (odds ratio, 0.45; confidence interval, 0.25–0.79, p = .0056). Conclusion CBA was associated with fewer complications, and shorter procedure times, and greater fluoroscopy times, compared to RFA. Nonpulmonary vein ablation and electroanatomic mapping system use was common with CBA.

The role of posterior wall isolation in catheter ablation of persistent atrial fibrillation

“…The ability for these studies to maximally inform clinical practice will depend on several study aspects, including the method of PWI, extent of non‐PVI lesions sets, intraprocedural definition of PWI, and study endpoints. Non‐pulmonary vein ablation with both RF and cryoballoon ablation of persistent AF most commonly includes only CTI ablation and floor line and roof line ablation 59 . As such, allowing additional empiric lesions (empiric mitral isthmus or superior vena cava ablations) or trigger ablation, although popular at certain centers, may decrease generalizability.…”

Primary results of the Spanish Cryoballoon Ablation Registry: acute and long-term outcomes of the RECABA study

“…The recent report from the Cryo AF Global Registry described primary outcomes of cryoablation used according to local practice around the world 4 . Country specific evaluations such as the GWTG-AFIB study, the FREEZE Cohort, and the 1STOP registry describe outcomes of cryoablation in the USA, Germany, and Italy, which have had many years of experience with the cryoablation catheter 5 – 7 . Uniquely, a recent report from Miyazaki et al described the first safety experience with cryoablation in Japan 8 .…”

Cryoballoon Catheter Ablation in Korean Patients With Paroxysmal and Persistent Atrial Fibrillation: One Year Outcome From the Cryo Global Registry

“… 9) The outcome of this Korean real-world evidence is compared below to registries around the globe. 10) 11) 12) 13) In addition, there are currently 2 publications on CBA-PVI in the Korean population for comparison of procedural outcome, and both are single-center experiences. 14) 15) …”

“…Patient demographics of Korean patients in this sub-analysis of the Cryo Global Registry were very comparable to what was previously reported for age, echocardiogram parameters, co-morbidities, number of failed AADs, and time to ablation. 9) 10) 11) 12) 13) The participating Korean centers enrolled a slightly higher number of males (75.3%) compared to other registries. Half of the Korean patients had non-PAF, which was also seen in the GWTG-AFIB registry, 10) but is higher than reported in the global cohort of the Cryo Global Registry.…”