Ice or fire? Comparison of second‐generation cryoballoon ablation and radiofrequency ablation in patients with symptomatic persistent atrial fibrillation and an enlarged left atrium

Akkaya, Ersan; Berkowitsch, Alexander; Zaltsberg, Sergej; Greiß, Harald; Hamm, Christian W.; Sperzel, Johannes; Neumann, Thomas; Kuniss, Malte

doi:10.1111/jce.13402

Cited by 24 publications

(27 citation statements)

References 23 publications

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“…Finally, we want to point out that we analyzed only patients undergoing PVI alone in this trial. Some of these patients have been previously reported (60 patients with relatively small left atria and “early persistent” AF as well as 63 patients—all of them with a LA area more than 20 cm 2 , considered to be enlarged—undergoing CB‐PVI compared with RF‐PVI) . Although PVI with CB‐Adv is effective and leads to both PVI and LA substrate modification, the use of CB‐Adv might be insufficient in patients with an enlarged left atrium due to larger residual substrate areas.…”

Section: Discussionmentioning

confidence: 99%

“…Although PVI with CB‐Adv is effective and leads to both PVI and LA substrate modification, the use of CB‐Adv might be insufficient in patients with an enlarged left atrium due to larger residual substrate areas. Possibly an additional LA roof ablation using CB‐Adv as described before may lead to better outcomes as PVI alone, especially in patients with enlarged left atria . Nevertheless, there are no randomized data comparing PVI alone with PVI and additional LA roof ablation in patients with persistent AF using the CB technique.…”

Section: Discussionmentioning

confidence: 99%

“…| 1505 better outcomes as PVI alone, 20 especially in patients with enlarged left atria 21. Nevertheless, there are no randomized data comparing PVI alone with PVI and additional LA roof ablation in patients with persistent AF using the CB technique.…”

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confidence: 99%

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Five‐year experience with pulmonary vein isolation using the second‐generation cryoballoon for treatment of persistent atrial fibrillation

Akkaya

Berkowitsch

Zaltsberg

et al. 2018

Cardiovasc electrophysiol

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Five‐year experience with pulmonary vein isolation using the second‐generation cryoballoon for treatment of persistent atrial fibrillation

Akkaya

Berkowitsch

Zaltsberg

et al. 2018

Cardiovasc electrophysiol

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“…For CBA, most studies used a second -generation cryoballoon as an ablation tool, except the study by Boveda et al, 8 which utilized a first -generation cryoballoon. For RFA, a contact force -sensing catheter was employed in 3 studies, 9,12,13 while the remaining studies utilized a standard open irrigated catheter. 10,11 Cryo -PVI in 2 CBA groups was reported with no touch -up RFA.…”

Section: What's New?mentioning

confidence: 99%

Cryoballoon versus radiofrequency ablation for persistent atrial fibrillation: a systematic review and meta‑analysis

Liu¹,

Gao²,

Jin³

et al. 2020

Kardiol Pol

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BACKGROUND Clinical outcomes of catheter ablation for persistent atrial fibrillation (AF) remain discouraging. AIMS This meta-analysis aimed to compare cryoballoon ablation (CBA) with radiofrequency ablation (RFA) for persistent AF. METHODS A systematic search of the PubMed, EMBASE, and Cochrane Library databases was performed for studies comparing the outcomes between CBA and RFA. Seven trials including 934 patients were analyzed. RESULTS There were no differences between groups in terms of freedom from atrial arrhythmia (risk ratio [RR], 1.04; 95% CI, 0.93-1.15; P = 0.52; I 2 = 0%), procedural complications (RR, 0.91; 95% CI, 0.52-1.59; P = 0.74; I 2 = 0%), atrial fibrillation or atrial tachycardia relapse during the blanking period (RR, 0.73; 95% CI, 0.50-1.06; P = 0.1; I 2 = 9%), repeat ablation (RR, 0.74; 95% CI, 0.45-1.21; P = 0.23; I 2 = 62%), and vascular complications (RR, 0.98; 95% CI, 0.42-2.27; P = 0.97; I 2 = 0%). Cryoballoon ablation increased the incidence of conversion to sinus rhythm during ablation (RR, 1.69; 95% CI, 1.01-2.83; P = 0.046; I 2 = 0%) and phrenic nerve palsy (PNP; RR, 3.05; 95% CI, 0.95-9.8; P = 0.06; I 2 = 0%), while RFA increased the risk of cardiac tamponade (RR, 0.27; 95% CI, 0.06-1.25; P = 0.09; I 2 = 0%). Subanalyses revealed a lower incidence of recurrent atrial arrhythmia and repeat ablation during CBA without touch-up RFA in pulmonary vein isolation. CONCLUSIONS CBA provides an alternative technique for persistent AF ablation. It might reduce the risk of repeat ablation and cardiac tamponade but increase the risk of PNP.

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“…A multicenter retrospective nonrandomized study revealed that CBG2 coupled with RFCA had a 76.6% success rate at 12 months compared to 60.4% for RFCA alone in PaAF and PeAF patients [38]. In the following years, several studies further demonstrated the advantages of a combination of CBG and RFCA [39,40].…”

Section: Longer Time Is Futile To Recurrencementioning

confidence: 99%

Strategies to Improve the Outcome of Cryoballoon Ablation in the Treatment of Atrial Fibrillation

Huang

Wang

Song

2020

BioMed Research International

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Atrial fibrillation (AF) is a common arrhythmia contributing to severe outcomes, including cardiac dysfunction and stroke, and it has drawn great attention around the world. Drug therapies have been available for many years to terminate AF and control heart rate. However, the results from clinical studies on drug therapies have been discouraging. Mounting evidence indicates that radiofrequency catheter ablation (RFCA) is a safe and effective method to maintain sinus rhythm, especially in patients who are drug intolerant or for whom the drugs are ineffective, although it is a technically demanding and complex procedure. Fortunately, a novel application, cryoballoon ablation (CBA), with outstanding characteristics has been widely used. Great outcomes based on CBA have manifested its significant role in the treatment of AF. However, how to improve the safety and efficacy of CBA is a question that has not been well-answered. Would it be helpful to develop a different generation of cryoballoon? Is bonus freezing beneficial, or not? Is it better to prolong freezing time? Dose CBA combined with RFCA bring higher success rates? In this review, we comprehensively summarized useful applications for improving outcomes of CBA in AF patients.

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Ice or fire? Comparison of second‐generation cryoballoon ablation and radiofrequency ablation in patients with symptomatic persistent atrial fibrillation and an enlarged left atrium

Abstract: Arrhythmia recurrence rates in the two groups during midterm follow-up were comparable. RL creation during CB-Adv ablation resulted in acceptable outcomes.

Cited by 24 publications

References 23 publications

Five‐year experience with pulmonary vein isolation using the second‐generation cryoballoon for treatment of persistent atrial fibrillation

Five‐year experience with pulmonary vein isolation using the second‐generation cryoballoon for treatment of persistent atrial fibrillation

Cryoballoon versus radiofrequency ablation for persistent atrial fibrillation: a systematic review and meta‑analysis

Strategies to Improve the Outcome of Cryoballoon Ablation in the Treatment of Atrial Fibrillation

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