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)?


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).


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%).


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


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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