Cryoablation vs. radiofrequency ablation for treatment of paroxysmal atrial fibrillation: a systematic review and meta-analysis

Chen, Yi-He; Lu, Zhao-Yang; Yin, Xiaoxing; Hou, Jianwen; Wang, Qian; Lin, Hui; Li, Yi‐Gang

doi:10.1093/europace/euw330

Cited by 54 publications

(52 citation statements)

References 37 publications

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“…In our study, cryoenergy was chosen as the preferred energy source for PVI. According to recent AF ablation guidelines and position papers, 15,16 cryoablation has been proven to be as effective as radiofrequency in PVI and less associated with intraprocedural thrombi. 17 An "extended" AF ablative approach (eg, posterior wall isolation or an isoprenaline challenge for extrapulmonary AF foci ablation), for which radiofrequency may be more effective, has not yet been introduced in the combined procedure protocol, and several recent experiences proved cryoablation PVI to be effective in both patients with persistent AF and those with long-standing persistent AF.…”

Section: Cryoballoon Ablation and Laac Combined Proceduresmentioning

confidence: 99%

Cryoballoon pulmonary vein ablation and left atrial appendage closure combined procedure: A long-term follow-up analysis

et al. 2019

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BACKGROUND The combined left atrial appendage closure (LAAC) and cryoenergy pulmonary vein isolation (PVI) procedure has been proven safe and effective in managing stroke in patients with nonvalvular atrial fibrillation (AF), although most data refer to procedures performed using radiofrequency as the main energy source. OBJECTIVE The purpose of this study was to evaluate long-term follow-up of patients with AF undergoing concomitant LAAC and cryoenergy PVI. METHODS Patients undergoing LAAC and cryoballoon PVI at our institution were enrolled. At 3, 6, and 24 months from the index procedure, we determined the atrial arrhythmia recurrence rate, the extent of LAAC, and the rate of cerebrovascular/bleeding events. RESULTS Forty-nine patients (mean age 69 6 8 years; 32/49 (67%) men; CHA 2 DS 2-VASc score 2.8 6 1.2; HAS-BLED score 3 6 1) with a guideline-recommended LAAC indication were included. Acute PVI and complete LAAC were achieved in 100% of patients. All patients completed at least 24 months of follow-up. At 8 weeks and 6 months, complete or satisfactory (,5 mm leak) LAAC rates were achieved in 40 (82%) and 9 (18%) and in 42 (86%) and 7 (14%) of patients, respectively. The overall freedom from atrial arrhythmia rate at 24 months was 29 (60%), and 45 (92%) of patients were off antithrombotic drugs. The observed annualized stroke and bleeding rates were 1% and 2%, respectively, a 71% and 60% risk reduction in comparison to event rates predicted from CHA 2 DS 2-VASc and HAS-BLED scores. CONCLUSION Concomitant cryoballoon ablation and LAAC procedures appear safe and effective at long-term follow-up, with high antithrombotic drug withdrawal rates at 24 months.

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Section: Cryoballoon Ablation and Laac Combined Proceduresmentioning

confidence: 99%

Cryoballoon pulmonary vein ablation and left atrial appendage closure combined procedure: A long-term follow-up analysis

et al. 2019

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“… However, recently, a meta‐analysis reported that no differences in the incidence of stroke/TIA were found between RFCA and CB‐A. The reason for the discrepancy between animal experiments and clinical practice is unclear. Rare incidence of stroke/TIA might be an important contributor which might result in an insufficient statistical power to detect differences between RFCA and CB‐A in current trials.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of uninterrupted low-intensity warfarin for cryoballoon ablation of atrial fibrillation in the elderly: A pilot study

Xing

Sheng

et al. 2018

J Clin Pharm Ther

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“…The efficacy and safety of cryoballoon ablation in paroxysmal AF, including more challenging or specific clinical settings such as elderly patients, patients with heart failure, or patients undergoing first-line ablation, have been confirmed in several other studies [8][9][10]. Cryoablation may have the additional advantage of shorter procedure times [11,12] and appears to be less operator-dependent and more reproducible compared with RF ablation [13]. This is an important aspect because success rates of RF ablation for AF are reported to be operator-dependent [14].…”

Section: Choice Of the Appropriate Techniquementioning

confidence: 91%

Catheter ablation of atrial fibrillation: current status, techniques, outcomes and challengesCatheter ablation of atrial fibrillation: current status, techniques, outcomes, and challenges

Hindricks¹,

Shamloo²,

Lenarczyk³

et al. 2018

Kardiol Pol

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Atrial fibrillation (AF) is the most common human arrhythmia. Interventional treatment with catheter ablation is an established technique that is increasingly applied and has become one of the main treatment modalities in patients with AF. Ablation results in significant improvement of symptoms and the quality of life. There is as yet no clear evidence of any impact of the procedure on hard clinical endpoints, except in patients with heart failure, who seem to benefit significantly from ablation. The cornerstone of the procedure is the achievement of pulmonary vein isolation. Radiofrequency energy is the main applied energy source, but cryoballoon ablation has emerged as a safe and effective alternative to radiofrequency ablation. Additional ablation strategies and novel technical features have been proposed but without unequivocal proof of clinical benefit. The most promising of these seems to be substrate mapping of the left atrium with substrate modification in areas with low voltage as an adjunct to pulmonary vein isolation. Complication rates remain considerable despite accumulated experience and can be partly reduced by application of preventive measures.

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Cryoablation vs. radiofrequency ablation for treatment of paroxysmal atrial fibrillation: a systematic review and meta-analysis

Abstract: Compared with RF ablation, cryoablation present a comparable long-term AF/atrial tachycardial-free survival and procedure-related adverse events. Meanwhile, cryoablation markedly shorten the procedure time, nonetheless, with negligible impact on the fluoroscopy time.

Cited by 54 publications

References 37 publications

Cryoballoon pulmonary vein ablation and left atrial appendage closure combined procedure: A long-term follow-up analysis

Cryoballoon pulmonary vein ablation and left atrial appendage closure combined procedure: A long-term follow-up analysis

Efficacy and safety of uninterrupted low-intensity warfarin for cryoballoon ablation of atrial fibrillation in the elderly: A pilot study

Catheter ablation of atrial fibrillation: current status, techniques, outcomes and challengesCatheter ablation of atrial fibrillation: current status, techniques, outcomes, and challenges

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