Cryoballoon versus RF Ablation in Paroxysmal Atrial Fibrillation: Results from the German Ablation Registry

Abstract

RF ablation is the most widespread ablation method in Germany, but use of cryoballoon increased significantly. Procedure times were similar, but ablation and fluoroscopy times were longer in cryoballoon ablation. No significant differences were found in terms of acute success and overall complication rate.

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…Całkowita PVI na poziomie przedsionków jest najlepiej udokumentowanym celem ablacji przezcewnikowej [716,[729][730][731], możliwym do uzyskania przez ablację prądem o wysokiej częstotliwości (RF) prowadzoną punkt po punkcie, wykonywanie liniowych uszkodzeń dookoła żył płucnych lub ablację za pomocą kriobalonu; wszystkie z podobnymi wynikami leczenia [732][733][734]. Całkowita PVI wiąże się z lepszymi wynikami leczenia pod względem utrzymywania rytmu zatokowego niż niecałkowita izolacja [716].…”

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…693 Many studies (mostly nonrandomized) showed that CBA yields similar or higher success rates in comparison to RF in patients presenting with drug-resistant PAF, and that the procedure is somewhat less time-consuming and might be associated with a safer profile. 482,694,695,696 More recently, the multicenter randomized clinical trial FIRE AND ICE, comparing conventional PVI with RFCA (force-sensing catheters were used in approximately 25% of the procedures) to CBA (CB-2 in approximately 75% of the procedures) in drug-refractory PAF has shown that CBA is noninferior to RFCA with respect to efficacy and overall safety.…”

Catheter Ablation of Lone Atrial Fibrillation

“…It is well known that cryoballoon isolation of the PVs is associated with the occurrence of this complication, and that the usage of balloon with a diameter smaller than 23 mm particularly increases complication risk (7.5%) due to more ostial energy application and distension of terminal part of the vein [190]. Recently, it has been reported that using balloons with a larger diameter (28 mm) the incidence of phrenic nerve palsy was reduced to 2.2%, but it was still significantly higher than while using RF current [136,173,192].…”

“…In clinical practice, the damage of right phrenic nerve is most frequently seen during the right superior PV isolation by cryoballoon and during the isolation of superior caval vein by RF ablation [3,8,136]. However, there are few reports on paresis of left phrenic nerve during cryoballoon isolation of the left inferior PV [191].…”

“…Data from the German registry included 3.775 patients with paroxysmal AF who underwent the PV isolation procedure [136]. A direct comparison of cryoballoon ablation and RF ablation indicated the identical overall complication rate (4.6% vs. 4.6%).…”