Cryoballoon versus Radiofrequency Catheter Ablation for Paroxysmal Atrial Fibrillation

Wasserlauf, Jeremiah; Pelchovitz, Daniel J.; Rhyner, John; Verma, Nishant; Bohn, R N Martha; Li, Zhi; Arora, Rishi; Chicos, Alexandru B.; Goldberger, Jeffrey J.; Kim, Susan S.; Lin, Albert; Knight, Bradley P.; Passman, Rod

doi:10.1111/pace.12582

Cited by 63 publications

(43 citation statements)

References 25 publications

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“…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 …”

Section: Resultsmentioning

confidence: 99%

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

Lavallaz

Clerc

Pudenz

et al. 2019

Cardiovasc electrophysiol

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Background: Atrial fibrillation (AF) is a growing healthcare burden, for which pulmonary vein isolation (PVI) using cryoballoon (CB) or radiofrequency (RF) represent attractive therapies. Women are at higher risk of recurrence after AF ablation and present a specific complications profile. Therefore, a systematic catheter‐specific assessment of pulmonary vein isolation is urgently needed in women. Objective: Systematically assessing the sex‐specific efficacy/safety of CB vs RF ablation. Methods: We performed a structured database search of the scientific literature for randomized controlled trials (RCTs) and observational prospective studies (OPS) comparing CB and RF ablation efficacy at 1 year. We investigated the reporting of sex‐specific analyses and assessed the comparative sex‐specific efficacy, safety and procedural characteristics of CB vs RF using random‐effect meta‐regression accounting for the proportion of enrolled women. Results: Twenty‐three studies were included (18 OPS and 5 RCTs) for a total of 13 509 patients. Sex‐specific outcomes by ablation device were reported in two and sex‐specific regression in four studies, none of which took the ablation device into account. Meta‐regression accounting for the proportion of enrolled women showed no significant difference in outcomes between RF or CB. Conclusion: The sex‐specific reporting in trials comparing CB to RF is extremely low. A quantitative meta‐regression using the percentage of enrolled women as sex‐specific indicator did not show any difference between CB and RF but acknowledging the low percentage of enrolled women and the lack of sex‐specific data, further research including patient‐level data is urgently needed to draw more definitive conclusions.

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Section: Resultsmentioning

confidence: 99%

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

Lavallaz

Clerc

Pudenz

et al. 2019

Cardiovasc electrophysiol

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“…In the pooled cohort, freedom from AT did not differ between CB (69.1%) and RF (63.1%) ablations. The success rate of ablation procedures was much lower in studies restricted to first‐generation CB (7 studies, 601/1,037 patients, 57.9%) and non‐CF sensing RF (8 studies, 1,550/2,667 patients, 58.1%). Although increased operator experience may also have contributed to improved results, advances in both CB technology (second‐generation CB, 78.1% freedom from AT) and RF ablations (CF‐sensing RF, 78.2% freedom from AT) have certainly been associated with increased procedural success rates.…”

Section: Discussionmentioning

confidence: 99%

Cryoballoon versus Radiofrequency Catheter Ablation in Atrial Fibrillation: A Meta‐Analysis

Cardoso

Mendirichaga

Fernandes

et al. 2016

Cardiovasc electrophysiol

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“…11 However, ablation is successful in only ~ 60–70% of individuals. 17, 27 Therefore, if a APC-related AF is found to be a distinct mechanistic phenotype, this may be a group particularly amenable to APC suppression for effective AF prevention or treatment.…”

Section: Discussionmentioning

confidence: 99%

Electrocardiographic Predictors of Incident Atrial Fibrillation

Nguyen

Vittinghoff

Dewland

et al. 2016

The American Journal of Cardiology

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Atrial fibrillation (AF) is likely secondary to multiple different pathophysiological mechanisms that are increasingly, but incompletely understood. Motivated by the hypothesis that 3 previously described electrocardiographic (ECG) predictors of AF identify distinct AF mechanisms, we sought to determine if these ECG findings independently predict incident disease. Among Cardiovascular Health Study participants without prevalent AF, we determined whether left anterior fascicular block (LAFB), a prolonged QTC, and atrial premature complexes (APCs) each predicted AF after adjusting for each other. We then calculated the attributable risk in the exposed for each ECG marker. LAFB and QTC intervals were assessed on baseline 12-lead ECG (n=4,696). APC count was determined using 24-hour Holter recordings obtained in a random subsample (n=1,234). After adjusting for potential confounders and each ECG marker, LAFB (hazard ratio [HR. 2.1, 95% confidence interval [CI. 1.1–3.9, p=0.023), a prolonged QTC (HR 2.5, 95% CI 1.4–4.3, p=0.002), and every doubling of APC count (HR 1.2, 95% CI 1.1–1.3, p<0.001) each remained independently predictive of incident AF. The attributable risk of AF in the exposed was 35% (95% CI 13–52%) for LAFB, 25% (95% CI 0.6–44%) for a prolonged QTC, and 34% (95% CI 26–42%) for APCs. In conclusion, in a community-based cohort, 3 previously established ECG-derived AF predictors were each independently associated with incident AF, suggesting they may represent distinct mechanisms underlying the disease.

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Cryoballoon versus Radiofrequency Catheter Ablation for Paroxysmal Atrial Fibrillation

Abstract: CBA was associated with equivalent 1-year FFAF rate as RFA for pAF. Procedure and fluoroscopy times were shorter for CBA and fewer cardiac perforations occurred.

Cited by 63 publications

References 25 publications

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

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

Cryoballoon versus Radiofrequency Catheter Ablation in Atrial Fibrillation: A Meta‐Analysis

Electrocardiographic Predictors of Incident Atrial Fibrillation

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