Outcomes of Cryoballoon or Radiofrequency Ablation in Symptomatic Paroxysmal or Persistent Atrial Fibrillation

Overview

Journal Europace

Publisher Oxford University Press

Specialties Cardiology & Vascular Diseases
Physiology

Date 2019 Jun 15

PMID 31199860

Citations 48

Authors

Ellen Hoffmann

Florian Straube

Karl Wegscheider

Malte Kuniss

Dietrich Andresen

Li-Qun Wu

Jurgen Tebbenjohanns

Georg Noelker

Roland Richard Tilz

Julian Kyoung Ryul Chun

Andreas Franke

Christoph Stellbrink

Arcadi Garcia-Alberola

Uwe Dorwarth

Andreas Metzner

Taoufik Ouarrak

Johannes Brachmann

Karl-Heinz Kuck

Jochen Senges

Affiliations

Soon will be listed here.

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.

Citing Articles

Long-term outcomes of cryoballoon versus robotic magnetic navigation guided radiofrequency ablation in patients with persistent atrial fibrillation.

Luo Q, Li X, Xie Y, Bao Y, Wei Y, Lin C Sci Rep. 2025; 15(1):6181.

PMID: 39979454 PMC: 11842544. DOI: 10.1038/s41598-025-90920-5.

Impact of Body Mass Index on the Outcomes of Cryoballoon Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation.

Papathanasiou K, Vrachatis D, Kossyvakis C, Giotaki S, Deftereos G, Kousta M Clin Pract. 2024; 14(6):2463-2474.

PMID: 39585020 PMC: 11587088. DOI: 10.3390/clinpract14060192.

Invasive strategies for rhythm control of atrial fibrillation: a narrative review.

Kim H, Lee C J Yeungnam Med Sci. 2024; 41(4):279-287.

PMID: 39307574 PMC: 11534407. DOI: 10.12701/jyms.2024.00703.

Efficacy and safety of radiofrequency ablation versus cryoballoon ablation for persistent atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials.

Amin A, Nawlo A, Ibrahim A, Hassan A, Saber A, Abuelazm M Egypt Heart J. 2024; 76(1):89.

PMID: 38976090 PMC: 11231113. DOI: 10.1186/s43044-024-00518-x.

Pulmonary Vein Isolation with Pulsed Field Ablation and Size-Adjustable Cryo-Balloon: A Comparative Procedural Analysis of First-Time Use.

Katov L, Teumer Y, Bothner C, Rottbauer W, Weinmann-Emhardt K J Clin Med. 2024; 13(11).

PMID: 38892824 PMC: 11172636. DOI: 10.3390/jcm13113113.

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