Cryoballoon versus radiofrequency ablation for persistent atrial fibrillation: a systematic review and meta‑analysis

Abstract

BACKGROUND Clinical outcomes of catheter ablation for persistent atrial fibrillation (AF) remain discouraging. AIMS This meta-analysis aimed to compare cryoballoon ablation (CBA) with radiofrequency ablation (RFA) for persistent AF. METHODS A systematic search of the PubMed, EMBASE, and Cochrane Library databases was performed for studies comparing the outcomes between CBA and RFA. Seven trials including 934 patients were analyzed. RESULTS There were no differences between groups in terms of freedom from atrial arrhythmia (risk ratio [RR], 1.04; 95% CI, 0.93-1.15; P = 0.52; I 2 = 0%), procedural complications (RR, 0.91; 95% CI, 0.52-1.59; P = 0.74; I 2 = 0%), atrial fibrillation or atrial tachycardia relapse during the blanking period (RR, 0.73; 95% CI, 0.50-1.06; P = 0.1; I 2 = 9%), repeat ablation (RR, 0.74; 95% CI, 0.45-1.21; P = 0.23; I 2 = 62%), and vascular complications (RR, 0.98; 95% CI, 0.42-2.27; P = 0.97; I 2 = 0%). Cryoballoon ablation increased the incidence of conversion to sinus rhythm during ablation (RR, 1.69; 95% CI, 1.01-2.83; P = 0.046; I 2 = 0%) and phrenic nerve palsy (PNP; RR, 3.05; 95% CI, 0.95-9.8; P = 0.06; I 2 = 0%), while RFA increased the risk of cardiac tamponade (RR, 0.27; 95% CI, 0.06-1.25; P = 0.09; I 2 = 0%). Subanalyses revealed a lower incidence of recurrent atrial arrhythmia and repeat ablation during CBA without touch-up RFA in pulmonary vein isolation. CONCLUSIONS CBA provides an alternative technique for persistent AF ablation. It might reduce the risk of repeat ablation and cardiac tamponade but increase the risk of PNP.

Cryoballoon pulmonary vein isolation as a standard approach for interventional treatment of atrial fibrillation. A review and a practical guide to an effective and safe procedure

“…Both CB and RF ablation techniques are considered as standard methods with similar outcomes. However, based on the largest comparison of both techniques -the "Fire and Ice study" -patients after CB ablation had significantly fewer all-cause re-hospitalizations, cardiovascular re-hospitalizations, re-ablations, and direct current cardioversions after the index procedure [2,16,24,25]. In our opinion there are several important advantages of CB ablation making it the preferred approach.…”

Early arrhythmia recurrence after cryoballoon ablation in atrial fibrillation: A systematic review and meta‐analysis

“…A retrospective analysis of 678 patients from AXAFA-AFNET 5 trial showed that ER occurrence is not associated to energy source applied 5 and a recent meta-analysis proves that arrhythmia relapse during BP does not differ in RFA-and CBAtreated patients (relative risk: 0.73; 95% CI: 0.50-1.06; p = .1). 41 All the aforementioned data highlight that irrespective of energy source, early arrhythmia recurrence is correlated with poor arrhythmia-free survival in the long term.…”

Effectiveness of Radiofrequency Catheter Ablation Using Ablation Index Versus Second Generation Cryoballoon in the Treatment of Persistent Atrial Fibrillation: A Matching-Adjusted Indirect Comparison

“…Contemporary meta-analytic studies have sought to assess the comparative efficacy of RF and CB ablation for AF [21][22][23]; however, these analyses included mixed AF types and/or generations of ablation technologies, precluding comparison of the latest generations of RF and CB technologies available for the treatment of PsAF. A meta-analysis by Liu and colleagues [23] is the first to compare the efficacy and safety of cryoablation and RF ablation in PsAF ablation. The analysis found that there was no difference in terms of freedom from atrial arrhythmia between cryoablation and RF ablation (RR 1.04; 95% CI 0.93-1.15; P = 0.52) [23].…”

“…A meta-analysis by Liu and colleagues [23] is the first to compare the efficacy and safety of cryoablation and RF ablation in PsAF ablation. The analysis found that there was no difference in terms of freedom from atrial arrhythmia between cryoablation and RF ablation (RR 1.04; 95% CI 0.93-1.15; P = 0.52) [23]. Importantly, studies included in the analysis differed with respect to study design, intervention (i.e., mixed generation and/or type of catheter), and ablation strategy (i.e., PVI alone, PVI plus additional ablations).…”