A Systematic Review and Meta-Analysis of the Direct Comparison of Second-Generation Cryoballoon Ablation and Contact Force-Sensing Radiofrequency Ablation in Patients with Paroxysmal Atrial Fibrillation

Abstract

The superiority of second-generation cryoballoon (2G-CB) ablation versus contact force-sensing radiofrequency (CF-RF) ablation in patients with paroxysmal atrial fibrillation (AF) was assessed in this systematic review and meta-analysis. Freedom from atrial tachyarrhythmias (ATAs) (OR = 0.89; 95% confidence interval [CI] = 0.68 to 1.17; p = 0.41), freedom from AF (OR = 0.93; 95% CI = 0.65 to 1.35; p = 0.72), and acute pulmonary vein isolation (PVI) (OR = 1.17; 95% CI = 0.54 to 2.53; p = 0.70) between 2G-CB ablation and CF-RF ablation were not different. The procedure time for the 2G-CB ablation was shorter (MD = −18.78 min; 95% CI = −27.72 to −9.85 min; p < 0.01), while the fluoroscopy time was similar (MD = 2.66 min; 95% CI = −0.52 to 5.83 min; p = 0.10). In the 2G-CB ablation group, phrenic nerve paralysis was more common (OR = 5.74; 95% CI = 1.80 to 18.31; p = < 0.01). Regarding freedom from ATAs, freedom from AF, and acute PVI, these findings imply that 2G-CB ablation is not superior to CF-RF ablation in paroxysmal AF. Although faster than CF-RF ablation, 2G-CB ablation has a greater risk of phrenic nerve paralysis.

Association between weight loss and outcomes in patients undergoing atrial fibrillation ablation: a systematic review and dose–response meta-analysis

“…Ablation strategy of the resting three observation studies [ 21 , 22 ] is unclear. Currently, a Systematic Review and Meta-Analysis [ 35 ] showed there was no significant difference of the clinical outcomes between cryoballoon ablation and radiofrequency, and the 2020 ESC guideline [ 12 ] of AF indicated that in the first procedure for paroxysmal AF, the outcomes of either strategies are analogous. Therefore, the heterogeneity due to different ablation strategies may not influence our result.…”

Novel scoring system derived from meta‐analysis and validated in cohort population for predicting 1‐year atrial fibrillation recurrence after cryoballoon catheter ablation: The HeLPS‐Cryo score

“…ReviewManager 5.4 (Cochrane, Copenhagen, Denmark) and Comprehensive Meta‐Analysis 3.0 (Biostat Inc., Englewood, New Jersey, US) were used to perform the meta‐analysis. The Cochrane's Q test p ‐value <0.1 or inconsistency index (I 2 ) ≥50% indicated heterogeneity 10 . The random‐effect analysis model was utilized to examine the pooled effects 2,8 .…”

“…The Cochrane's Q test pvalue <0.1 or inconsistency index (I 2 ) ≥50% indicated heterogeneity. 10 The random-effect analysis model was utilized to examine the pooled effects. 2,8 The inverse variance method was used to calculate pooled HR and 95% CI.…”

“…CBCA can be performed faster than RFCA but is more likely to paralyze the phrenic nerve. 10,11 Moreover, several major randomized controlled trials (RCTs) showed that the CBCA as the initial treatment strategy was better than antiarrhythmic drugs (AADs) in preventing recurrences in patients with paroxysmal AF. [12][13][14] After a 90-day blanking period, AF recurrence rates within 1 year after the CBCA procedure have been reported to be as high as 31% to 40%.…”

“…In terms of safety and efficacy, CBCA is comparable to RFCA. CBCA can be performed faster than RFCA but is more likely to paralyze the phrenic nerve 10,11 . Moreover, several major randomized controlled trials (RCTs) showed that the CBCA as the initial treatment strategy was better than antiarrhythmic drugs (AADs) in preventing recurrences in patients with paroxysmal AF 12–14 …”