Cryoballoon versus radiofrequency ablation for paroxysmal atrial fibrillation: a meta-analysis of randomized controlled trials

Murray, Marie‐Isabel; Arnold, Ahran; Younis, Murad; Varghese, Swaroop; Zeiher, Andreas M.

doi:10.1007/s00392-018-1232-4

Cited by 56 publications

(44 citation statements)

References 38 publications

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“…Out of the patients with reablation, we noted three patients with recurrence, the remainder were free from arrhythmias since the last procedure. With a recurrence rate around 30% after 12 months, previous publications reported comparable midterm results of CB‐guided AF ablation compared with conventional RF ablation 2,9,13,17 . This might be explained by our relatively healthy patient cohort with low comorbidities and fibrotic burden.…”

Section: Discussionsupporting

confidence: 53%

“…Pulmonary vein isolation (PVI) is considered as a first‐line treatment in patients suffering from paroxysmal atrial fibrillation (AF) and is regularly performed in patients with drug‐refractory AF 1 . Besides the conventional approach using radiofrequency (RF) energy, cryoballoon (CB) has emerged as a promising technique for successful and durable PVI 2 . In this context, the second generation CB (Arctic Front Advance™; Medtronic Inc., Minneapolis, MN, USA) was designed to further improve the acute efficacy of this single‐shot device for PVI.…”

Section: Introductionmentioning

confidence: 99%

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Cool enough? Lessons learned from cryoballoon‐guided catheter ablation for atrial fibrillation in young adults

Bergau

Hamriti

Rubarth

et al. 2020

Cardiovasc electrophysiol

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Introduction Cryoballoon (CB)‐guided ablation of atrial fibrillation (AF) is established in symptomatic AF patients. This study sought to determine the safety and efficacy of CB pulmonary vein isolation (PVI) in young adults. Methods and Results A total of 93 consecutive patients aged <45 years referred to our center for AF ablation were included in this observational study. All patients received CB‐guided PVI according to a standardized institutional protocol. Follow‐up was performed in our outpatient clinic using 72‐h Holter monitoring and periodic telephone interview. Recurrence was defined as any AF/atrial tachycardia (AT) episode >30 s following a 3‐month blanking period. A propensity matched control group consisting of patients older than 45 years were used for further evaluation. Mean age was 35 ± 7 years, 22% suffered from persistent AF, 85% were male. Mean follow‐up was 2.6 ± 2 years. At the end of the observational period, 83% of patients were free of any AF/AT episodes. There was an excellent overall 12‐month success rate of 92%. In comparison to a matched group the overall recurrence rate was noticeably lower in the young group (15% vs. 27%). Increasing age was associated with a hazard ratio of 1.16 for recurrence. In a multivariate analysis model, left atrial diameter remained as significant predictor of AF/AT recurrence. The complication rate was low, no permanent phrenic nerve palsy was observed. Conclusion CB‐guided PVI in young adults is safe and effective with favorable long‐term results. It may be considered as first‐line therapy in this relatively healthy population.

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Section: Discussionsupporting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Cool enough? Lessons learned from cryoballoon‐guided catheter ablation for atrial fibrillation in young adults

Bergau

Hamriti

Rubarth

et al. 2020

Cardiovasc electrophysiol

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“…In group A (conventional group), the degree of PV occlusion prior to each freeze cycle was filmed (cine run). In group B (intervention group), the following modifications were made: (1) degree of PV occlusion prior to each freeze cycle was only visualized by fluoroscopy and stored with the "store fluoroscopy" function (no cine run); (2) increased radiation awareness (e.g., optimal collimation, minimizing distance between patient and detector, limiting fluoroscopy) ( Fig. 1).…”

Section: Fluoroscopy Settingsmentioning

confidence: 99%

“…PVI is the cornerstone of AF ablation and most patients with AF will receive only a PVI during their index ablation procedure. Previous studies have shown that the clinical efficacy and safety of PVI using either RF or CB ablation is comparable [1,2,9], independent of the use of contact-force catheters and the type of AF (paroxysmal versus non-paroxysmal) [3,[10][11][12]. During the past decade, CB ablation has emerged as an attractive single-shot alternative to RF ablation.…”

Section: Advantages Of Cryoballoon Ablationmentioning

confidence: 99%

“…CB ablation offers a simpler and less operator-dependent means of achieving PVI by producing a large circular ablation zone. The landmark FIRE AND ICE trial and a recent meta-analysis showed that CB PVI was noninferior to RF ablation with respect to efficacy and safety [1,2]. The CIRCA-DOSE trial reconfirmed the noninferiority of second-generation CB PVI when compared with contact-force-guided RF ablation [3].…”

Section: Introductionmentioning

confidence: 99%

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Reducing radiation exposure in second-generation cryoballoon ablation without compromising clinical outcome

Holl

Bhagwandien

Firouzi

et al. 2020

J Interv Card Electrophysiol

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Purpose Pulmonary vein isolation (PVI) using cryoballoon (CB) ablation is associated with an increased radiation exposure compared with radiofrequency ablation. Previous studies showed that radiation exposure in CB PVI can be reduced by optimizing the fluoroscopy protocol without comprising acute efficacy and safety. We evaluated the mid-term outcome of a modified fluoroscopy protocol in patients undergoing CB PVI. Methods The study population comprised 90 consecutive patients who underwent second-generation CB-based PVI. The first 46 patients underwent CB PVI with conventional fluoroscopy settings (group A, historic control group). In the following 44 patients (group B), a modified fluoroscopy protocol was applied consisting of (1) visualization of degree of PV occlusion only by fluoroscopy (no cine runs); (2) increased radiation awareness. Primary endpoints were the total dose area product (DAP), fluoroscopy time, and freedom from documented recurrence of atrial fibrillation (AF) after a single procedure. Results Group B had a lower median DAP (1393 cGycm 2 vs. 3232 cGycm 2 , P < 0.001) and median fluoroscopy time (20 min vs. 24 min, P < 0.001) as compared with group A. The 1-year freedom from documented recurrence of AF after a single procedure was similar among groups (74% in group A vs. 77% in group B, P = 0.71). There were no significant differences between both groups for the secondary endpoints, including procedure duration, proportion of patients with complete electrical isolation, and complications. Conclusion Using a modified fluoroscopy protocol and increased radiation awareness, radiation exposure can be significantly reduced in CB PVI with a similar 1-year clinical outcome.

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The effect of left atrial remodeling after cryoballoon ablation and radiofrequency ablation for paroxysmal atrial fibrillation

Wang

Song

Qiu

et al. 2020

Clinical Cardiology

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BackgroundCryoballoon ablation (CBA) and radiofrequency ablation (RFA) are the most common procedures used to treat refractory atrial fibrillation (AF) and are performed through pulmonary vein isolation (PVI). Studies have shown that CBA can approximately match the therapeutic effects of RFA against AF. However, few studies have investigated the difference between CBA and RFA of the effects on left atrial remodeling for paroxysmal AF.ObjectiveAtrial remodeling is considered pivotal to the occurrence and development of AF, therefore we sought to assess the influence of atrial remodeling in patients with paroxysmal AF after CBA and RFA in this study.MethodsIn this nonrandomized retrospective observational study, we enrolled 328 consecutive patients who underwent CBA or RFA for refractory paroxysmal AF in May 2014 to May 2017 in our hospital. After propensity score matching, 96 patients were included in the CBA group, and 96 were included in the RFA group. Patients were asked to undergo a 12‐lead electrocardiogram, a 24‐h Holter monitor, and an echocardiogram and to provide their clinical history and symptoms at 6 months and 1, 2, and 3 years postprocedurally. Electrical remodeling of the left atrium was assessed by P wave dispersion (Pdis); structural remodeling was assessed by the left atrium diameter (LAD) and left atrial volume index (LAVI) during scheduled visits.ResultsAs of January 2020, compared with baseline, at 1 year, 2 years, and 3 years after ablation, the average changes in Pdis (∆Pdis), LAD (∆LAD), and LAVI (∆LAVI) were significant in both the CBA and RFA groups. Six months after ablation, ∆Pdis, ∆LAD, and ∆LAVI were greater in the CBA group than in the RFA group. There was no significant difference between the two groups in AF/flutter recurrence, but the AF/flutter‐free survival time of CBA group may be longer than RFA group after 2 years after ablation. A higher ∆Pdis, ∆LAD, or ∆LAVI at 1 year after ablation may increase AF/flutter‐free survival.ConclusionsAlthough CBA and RFA are both effective in left atrial electrical and structural reverse‐remodeling in paroxysmal AF, CBA may outperform RFA for both purposes 6 months after ablation. However, during long‐term follow‐up, there was no significant intergroup difference.

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Cryoballoon versus radiofrequency ablation for paroxysmal atrial fibrillation: a meta-analysis of randomized controlled trials

Abstract: Our systemic review and meta-analysis revealed further evidence that cryoballoon ablation is an equally effective alternative procedure to the standard radiofrequency treatment with a slightly, non-significant higher freedom from AF 1 year after the ablation and a shorter procedure time.

Cited by 56 publications

References 38 publications

Cool enough? Lessons learned from cryoballoon‐guided catheter ablation for atrial fibrillation in young adults

Cool enough? Lessons learned from cryoballoon‐guided catheter ablation for atrial fibrillation in young adults

Reducing radiation exposure in second-generation cryoballoon ablation without compromising clinical outcome

The effect of left atrial remodeling after cryoballoon ablation and radiofrequency ablation for paroxysmal atrial fibrillation

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