Cryoablation vs. Radiofrequency Ablation in Paroxysmal AF

Study Questions:

Are there any differences in outcomes between patients with paroxysmal atrial fibrillation (AF) who undergo cryoablation or radiofrequency ablation (RFA)?

Methods:

The data for this study were collected in a prospective, multicenter registry of 2,306 patients with paroxysmal AF who underwent pulmonary vein isolation using either a first-generation cryoballoon catheter (n = 607) or point-by-point RFA with an irrigated-tip catheter (n = 1,699). One of the safety endpoints was a composite of death, myocardial infarction, and stroke (MACCE).

Results:

There was no significant difference in the 1-year AF recurrence rate between the cryoablation group (45.8%) and the RFA group (45.4%). A redo ablation procedure was more common in the RFA group (23.5%) than in the cryoablation group (18.9%). There was not a significant difference in the incidence of MACCE at 500 days between the cryoablation group (0.7%) and the RFA group (1.4%). The only complication that was significantly more prevalent in one group than the other was phrenic nerve paresis, which was more common in the cryoablation group (2.2% vs. 0.1%).

Conclusions:

The AF recurrence rate and safety of cryoballoon ablation and RFA to isolate the pulmonary veins are similar.

Perspective:

The comparisons in this registry study have only limited clinical value because the newest-generation catheters (the second-generation cryoballoon catheter and force-sensing RFA catheters) were not available at the time the procedures were performed. However, more recently performed randomized studies (e.g., FIRE AND ICE, Kuck KH, et al., N Engl J Med 2016;Apr 4:[Epub ahead of print]) have indicated that the safety and efficacy of cryoablation and RFA still do not differ significantly. The major advantage of cryoballoon ablation is a significantly shorter procedure time.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias

Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Cardiac Catheters, Catheter Ablation, Cryosurgery, Myocardial Infarction, Phrenic Nerve, Pulmonary Veins, Stroke, Treatment Outcome


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