Cryoballoon vs. open irrigated radiofrequency ablation for paroxysmal atrial fibrillation: long-term FreezeAF outcomes

Abstract

BackgroundEffective treatment of paroxysmal atrial fibrillation (AF) is essential for reducing the risk of stroke and heart failure. Cryoballoon (CB) ablation has been developed as an alternative to the use of radiofrequency (RF) energy for electrical isolation of the pulmonary veins. Herein, we provide long-term data regarding the efficacy of CB ablation in comparison to RF.MethodsFreezeAF was a randomised non-inferiority study comparing CB ablation with RF ablation for the treatment of patients with drug-refractory paroxysmal AF. Procedural success for the long-term follow-up (30 months) was defined as freedom from AF with an absence of persistent complications.ResultsOf the 315 patients that were randomised and received catheter ablation, 292 (92.7%) completed the 30-month follow-up (147 in the RF group and 145 in the CB group). The baseline characteristics of the RF and CB groups were similar. Single-procedure success was achieved by 40% of patients in the RF group and 42% of the CB group (p < 0.001 for non-inferiority). When including re-do procedures in the analysis, the multiple procedure success rate was 72% in the RF group and 76% in the CB group.ConclusionThe data provide long-term evidence that CB ablation is non-inferior to RF ablation, with high proportions of patients reporting freedom from AF 30 months after the index procedure.Trial registration ClinicalTrials.gov Identifier: NCT00774566; first registered October 16, 2008; first patient included October 20, 2008.

Comparing between second‐generation cryoballoon vs open‐irrigated radiofrequency ablation in elderly patients: Acute and long‐term outcomes

“…Furthermore, data on CA of AF stated that 0.3 to 1.3% patients of the CB ablation and 1.3 to 1.9% patients of the RF ablation suffered cardiac tamponade . In the current study, three patients experienced pericardial tamponade (0.92%); one patient in the CB‐2 group and two patients in the RF group.…”

Sex‐specific efficacy and safety of cryoballoon versus radiofrequency ablation for atrial fibrillation: A systematic review and meta‐analysis

“…50 full‐text publications were reviewed, of which 27 were excluded: 19 based on the same cohorts, 6 focused on one type of complication and 2 with data not allowing extraction (Figure S1). 23 studies were finally included in the present systematic review and meta‐analysis …”

“…In a second step, we assessed the effect of sex on efficacy, safety, and procedural endpoints. The efficacy endpoint was the recurrence of atrial arrhythmia, as well as, for some studies, the need for repeat ablation or the use of antiarrhythmic drugs. This endpoint was assessed 12 months after the index ablation following a 90‐day blanking period.…”

“…23 studies were finally included in the present systematic review and metaanalysis. 4,5,8,[24][25][26][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] Baseline patient characteristics for these 23 studies are presented in Table 1. Included studies were published between 2010 and 2018, with enrollment starting from 2007 to 2015.…”

Incomplete endothelialization of WatchmanTM Device: Predictors and Implications from Two Cases

“…Regarding the comparison between the two ablation techniques, long term outcomes of the FreezeAF published by Armin Luik et al [20] provided data comparing the efficacy of CB2 ablation vs. RF showing that CB2 was non-inferior to RF. This was seen in our study, suggesting that those patients that underwent PVI using CB2 and had no recurrence during the first year, will not experience VLR due to PV reconnection at all.…”