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AF Progression After Cryoablation vs. RF Ablation: CIRCA-DOSE Trial
Quick Takes
- Randomization to radiofrequency ablation was associated with less patients experiencing an episode of persistent atrial tachyarrhythmia, as determined by implantable cardiac monitors, compared to cryoballoon ablation.
- Pulmonary vein isolation using radiofrequency energy is more effective than cryoballoon ablation in preventing “progression” to persistent AF and enabling regression to paroxysmal AF.
- All ablation technologies and modalities are not equally efficacious in modifying disease progression, and based on this study, radiofrequency ablation should be the preferred modality.
Study Questions:
What is the impact of the type of ablation energy on progression to persistent atrial tachyarrhythmia?
Methods:
The CIRCA-DOSE study investigators enrolled and randomized 346 patients with drug-refractory paroxysmal atrial fibrillation (AF) to contact-force guided radiofrequency ablation (CF-RF ablation, n = 115), 4-minute cryoballoon ablation (CRYO-4, n = 115), or 2-minute cryoballoon ablation (CRYO-2, n = 116). Implantable cardiac monitors placed at study entry were used for follow-up. The main outcome was the first episode of persistent atrial tachyarrhythmia. Secondary outcomes included atrial tachyarrhythmia recurrence, and arrhythmia burden on implantable monitor.
Results:
At a median of 944.0 (interquartile range [IQR], 612.5–1,104) days, 0 of 115 patients (0.0%) randomly assigned to CF-RF, 8 of 115 patients (7.0%) assigned to CRYO-4, and 5 of 116 patients (4.3%) assigned to CRYO-2 experienced an episode of persistent atrial tachyarrhythmia (p = 0.03). A documented recurrence of any atrial tachyarrhythmia ≥30 seconds occurred in 56.5%, 53.9%, and 62.9% of those randomized to CF-RF, CRYO-4, and CRYO-2, respectively (p = 0.65). Compared to the pre-ablation monitoring period, AF burden was reduced by a median of 99.5% (interquartile range [IQR] 94.0–100.0%) with CF-RF, 99.9% (IQR 93.3–100.0%) with CRYO-4, and 99.1% (IQR 87.0–100.0%) with CRYO-2 (p = 0.38).
Conclusions:
The authors report that catheter ablation of paroxysmal AF using radiofrequency energy was associated with fewer patients developing persistent AF on follow-up.
Perspective:
This randomized study reports that randomization to radiofrequency ablation was associated with less patients experiencing an episode of persistent atrial tachyarrhythmia, as determined by implantable cardiac monitors, compared to cryoballoon ablation. These data suggest that pulmonary vein isolation using radiofrequency energy is more effective than cryoballoon ablation in preventing “progression” to persistent AF and enabling regression to paroxysmal AF. These differences suggest that all ablation technologies and modalities are not equally efficacious in modifying disease progression, and based on this study, radiofrequency ablation should be the preferred modality.
Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure
Keywords: Ablation, Arrhythmias, Cardiac, Atrial Fibrillation, Disease Progression, ESC Congress, ESC23, Heart Failure, Pulmonary Veins, Radiofrequency Ablation, Secondary Prevention
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