Efficacy comparison between cryoablation and radiofrequency ablation for patients with cavotricuspid valve isthmus dependent atrial flutter: a meta-analysis

Abstract

We perform this meta-analysis to compare the efficacy and safety of cryoablation versus radiofrequency ablation for patients with cavotricuspid valve isthmus dependent atrial flutter. By searching EMBASE, MEDLINE, PubMed and Cochrane electronic databases from March 1986 to September 2014, 7 randomized clinical trials were included. Acute (risk ratio[RR]: 0.93; P = 0.14) and long-term (RR: 0.94; P = 0.08) success rate were slightly lower in cryoablation group than in radiofrequency ablation group, but the difference was not statistically significant. Additionally, the fluoroscopy time was nonsignificantly reduced (weighted mean difference[WMD]: −2.83; P = 0.29), whereas procedure time was significantly longer (WMD: 25.95; P = 0.01) in cryoablation group compared with radiofrequency ablation group. Furthermore, Pain perception during the catheter ablation was substantially less in cryoabaltion group than in radiofrequency ablation group (standardized mean difference[SMD]: −2.36; P < 0.00001). Thus, our meta-analysis demonstrated that cryoablation and radiofrequency ablation produce comparable acute and long-term success rate for patients with cavotricuspid valve isthmus dependent atrial flutter. Meanwhile, cryoablation ablation tends to reduce the fluoroscopy time and significantly reduce pain perception in cost of significantly prolonged procedure time.

Focal cryoballoon versus radiofrequency ablation of dysplastic Barrett’s esophagus: impact on treatment response and postprocedural pain

“…A large number of comparative studies including several randomized trials in this regard consistently demonstrate that CRYO is less painful compared with RFA. 19,[35][36][37] Although no concrete definition exists for clinically rele-vant differences in pain, a difference of 20% is frequently reported in this regard.38,39 Both the cumulative pain score (median 22 vs 4) and the peak pain score (median 4 vs 2) after RFA were >20% higher compared with CRYO. The absolute pain scores were, however, relatively low.…”

Ultralow temperature cryoablation using near‐critical nitrogen for cavotricuspid isthmus‐ablation, first‐in‐human results

“…Cryoablation has evolved as a safe alternative to radiofrequency (RF) ablation in the ablation of supraventricular arrhythmias. [1][2][3][4][5][6] Potential advantages of cryothermal energy are catheter stability due to adherence to myocardial tissue, the ability of reversible cryomapping mitigating the risk of permanent damage to critical structures like the atrioventricular (AV) node, a low risk of thrombus formation and systemic embolization, and a low probability of myocardial perforation due to the preservation of tissue architecture. 1,2,5,[7][8][9][10] Yet, efficacy of cryoablation using gaseous cryogens may be hampered by physiological reversibility of cellular injury when ablation times are too short or freezing temperatures not low enough, allowing thicker areas of myocardium to recover from freezing injury and recurrence of arrhythmias to occur.…”

“…New technologies aim to improve the efficacy, speed and durability of ablation treatment. Cryoablation has evolved as a safe alternative to radiofrequency (RF) ablation in the ablation of supraventricular arrhythmias 1–6 . Potential advantages of cryothermal energy are catheter stability due to adherence to myocardial tissue, the ability of reversible cryomapping mitigating the risk of permanent damage to critical structures like the atrioventricular (AV) node, a low risk of thrombus formation and systemic embolization, and a low probability of myocardial perforation due to the preservation of tissue architecture 1,2,5,7–10 .…”

Robust GPU-based virtual reality simulation of radio-frequency ablations for various needle geometries and locations

“…a liver blood vessel has a constant temperature of 37 • C. The temperature flow in the human body consists of three constituents [1]: (1) Heat conduction from warm to cold tissue. (2) Cooling by blood flow [31]. (3) Metabolic heat generation.…”

“…Radiation tip brachytherapy is more common in the lower abdomen targeting the cervix or prostate [22,21]. The treatment of spherical or ellipsoidal tumours is faster, subject to shorter fluoroscopy exposition and more painless [2] with cryotherapy [12], which destroys tumour cells with ice crystals from quick freezing and thawing [29]. Transarterial chemoembolization (TACE) is another treatment option (yet more side effects) for rather small or otherwise unresectable tumours extending the lifetime of patients [15].…”