Background: Pulmonary vein isolation (PVI), the standard for atrial fibrillation (AF) ablation, is most commonly applied with radiofrequency (RF) energy, although cryoballoon technology (CRYO) has gained widespread use.
Purpose: The aim was to compare the second generation cryoballoon and the irrigated RF energy regarding outcomes and safety.
Methods: In total, 4657 patients undergoing their first AF ablation were included; 982 with CRYO and 3675 with RF energy from the Swedish catheter ablation registry and the ESC- EHRA Atrial Fibrillation Ablation Long-Term registry. Primary endpoint was repeat AF ablation. Major secondary endpoints included procedural duration, tachyarrhythmia recurrence (>30 seconds duration) and complication rate.
Results: The re-ablation rate after 12 months of follow-up was significantly lower in the CRYO versus the RF group, 7.8% versus 11%, p=0.0041 (Figure 1), while freedom from arrhythmia recurrence did not differ between the groups, 70.2% versus 68.2%, p=0.44. The result was not influenced by AF type and RF lesion sets. In multiple Cox regression analysis, paroxysmal AF patients had significantly lower re-ablation risk after CRYO ablation, hazard ratio 0.56 (p=0.041). Procedural duration was significantly shorter with CRYO than RF, (mean±SD) 133.6±45.2 minutes versus 174.6±58.2 minutes, p<0.001. Complication rates did not differ; 53/982 (5.4%) versus 191/3675 (5.2%), CRYO versus RF, p=0.806.
Conclusion: The cryoballoon was superior to conventional RF energy by its lower re-ablation rates and shorter procedure times, irrespective of RFablation lesion set used, and with equal safety, which has important clinical and health economic implications.
Oxford University Press, 2018. Vol. 39, p. 52-52