First-line catheter ablation of paroxysmal atrial fibrillation: outcome of radiofrequency vs. cryoballoon pulmonary vein isolation

Straube, Florian; Dorwarth, Uwe; Ammar-Busch, Sonia; Peter, Timo; Noelker, Georg; Massa, Thomas; Kuniss, Malte; Ewertsen, Niels Christian; Chun, K.R. Julian; Tebbenjohanns, Juergen; Tilz, Roland Richard; Kuck, Karl Heinz; Ouarrak, Taoufik; Senges, Jochen; Hoffmann, Ellen

doi:10.1093/europace/euv271

Cited by 71 publications

(53 citation statements)

References 21 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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“…Overall, 373 of 4184 (8.9 %) patients were identified as first-line PAF patients undergoing AF ablation. After 1.4 years of follow-up, freedom from AF/atrial tachycardia was similar between RF 61 % and cryoablation 71 %, P = 0.11 [34]. Major events occurred similarly (cryoablation 1.6 % vs RF 3.7 % P = 0.22).…”

Section: Safety Profilementioning

confidence: 80%

Catheter Ablation as First-Line Therapy for Atrial Fibrillation: Ready for Prime-Time?

Carrizo

Morillo

2016

Curr Cardiol Rep

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Current guidelines include atrial fibrillation (AF) catheter ablation as part of the management strategy in patients that have failed at least one oral antiarrhythmic drug treatment course. However, growing evidence derived from both randomized and non-randomized studies demonstrate lower rates of AF recurrence and AF burden in patients with paroxysmal AF that are naïve to antiarrhythmic drug treatment. Furthermore, progression from paroxysmal AF to persistent AF appears to be delayed by early catheter ablation of AF. The current review addresses the question of the best timing for ablation in patients with paroxysmal AF and provides the rationale for offering AF ablation as first-line therapy based on the most updated evidence available.

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“…Previous studies comparing RF ablation with cryoballoon ablation have found comparable results of these two technologies [3][4][5][6][7]. Only a small number of studies showed a higher efficacy of cryoballoon ablation [8][9][10] and a trend for more recurrences and complications in the RF group (probable due to more favorable risk profile in patients undergoing cryoballoon ablation) [11]. In this study, RF ablation has had similar results as cryoballoon ablation at 12 months.…”

Section: Resultsmentioning

confidence: 99%

Outcomes and predictors of recurrences after pulmonary vein isolation by cryoballoon or radiofrequency catheter atrial fibrillation ablation

Grecu¹,

Floria²,

Hurjui³

et al. 2017

Arch Clin Cases

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Aim: Catheter-based pulmonary vein isolation (PVI) has become a new option treatment for drug-resistant and symptomatic paroxysmal atrial fibrillation (AF). We aimed to assess the outcomes after radiofrequency and cryoballoon catheter AF ablation. Material and methods: We performed a single-center prospective clinical study enrolling patients who underwent catheter ablation for paroxysmal AF between 2013 and 2015. The main objective was the outcomes after AF ablation by cryoballoon or radiofrequency energy. Follow-up was performed at 3, 6 and 12 months after ablation. Results: A total of 85 patients were included: 64 assigned to radiofrequency and 21 to cryoballoon ablation. Overall success rate at 3, 6 and 12 months post-ablation was 62%, 76% and 75%, respectively. Redo procedure was required in 8 patients (10.3%) at 6 months. Success rate at 12 months was non-significantly higher in radiofrequency ablation group (76% versus 62%; p=0.56). Complication rates were equivalent, without life treating or permanent sequels. Men gender, AF duration, obesity and sleep apnoea syndrome were clinical predictors of AF recurrence at 12 months after procedure. Conclusions: Cryoballoon and radiofrequency ablation appear to be safe and effective procedures for AF treatment, with similar success rate. Men gender, AF duration, obesity and sleep apnea syndrome seem to be associated with AF recurrence after ablation.

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First-line catheter ablation of paroxysmal atrial fibrillation: outcome of radiofrequency vs. cryoballoon pulmonary vein isolation

Abstract: NCT01360008.

Cited by 71 publications

References 21 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

Catheter Ablation as First-Line Therapy for Atrial Fibrillation: Ready for Prime-Time?

Outcomes and predictors of recurrences after pulmonary vein isolation by cryoballoon or radiofrequency catheter atrial fibrillation ablation

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