Radiofrequency vs. Cryoballoon vs. Thoracoscopic Surgical Ablation for Atrial Fibrillation: A Single-Center Experience

Abstract

Background and Objectives: Cryoballoon ablation (CBA) and totally thoracoscopic surgical ablation (TTA) have emerged as alternatives to radiofrequency catheter ablation (RFCA) for atrial fibrillation. In this study, we describe our experience comparing patient characteristics and outcomes of RFCA, CBA, and TTA. Materials and Methods: We retrospectively analyzed data from patients who underwent RFCA, CBA, or TTA. Both atrial fibrillation (AF)- and atrial tachyarrhythmia (ATa)-free survival rates were compared using time to recurrence after a 3-month blanking period (defined by a duration of more than 30 s). All patients were regularly followed using 12-lead ECGs or Holter ECG monitoring. Results: Of 354 patients in this study, 125 underwent RFCA, 97 underwent CBA and 131 underwent TTA. The TTA group had more patients with persistent AF, a larger LA diameter, and a history of stroke. The CBA group showed the shortest procedure time (p < 0.001). The CBA group showed significantly lower AF-free survival at 12 months than the RFCA and TTA groups (RFCA 84%, CBA 74% and TTA 85%, p = 0.071; p = 0.859 for TTA vs. RFCA, p = 0.038 for RFCA vs. CBA and p = 0.046 for TTA vs. CBA). There were no significant differences in ATa-free survival among the three groups (p = 0.270). There were no procedure-related adverse events in the RFCA group, but some complications occurred in the CBA group and the TTA group (6% and 5%, respectively). Conclusions: RFCA and CBA are effective and safe as first-line treatments for paroxysmal and persistent AF. In some high-risk stroke patients, TTA may be a viable option. It is important to consider patient characteristics when selecting an ablation method for AF.

Cryoballoon Catheter Ablation in Korean Patients With Paroxysmal and Persistent Atrial Fibrillation: One Year Outcome From the Cryo Global Registry

“…Adjunctive pre- and peri-procedural imaging and monitoring were frequently used. CBA procedure duration in this multicenter analysis (76±21 minutes) was relatively short when compared to the 2 published studies from Korea and other real-world evidence (ranging from 73±26 minutes to 136.0±46.5 minutes) 9) 10) 11) 12) 13) 14) 15) especially when considering the number of ablations beyond PVI in this sub-analysis. A history of AFL at baseline was documented in 20.7% of patients, which explains the relatively high number of CTI ablations (22.1%) performed at the index procedure.…”

“…Patient demographics of Korean patients in this sub-analysis of the Cryo Global Registry were very comparable to what was previously reported for age, echocardiogram parameters, co-morbidities, number of failed AADs, and time to ablation. 9) 10) 11) 12) 13) The participating Korean centers enrolled a slightly higher number of males (75.3%) compared to other registries. Half of the Korean patients had non-PAF, which was also seen in the GWTG-AFIB registry, 10) but is higher than reported in the global cohort of the Cryo Global Registry.…”

“… 9) The outcome of this Korean real-world evidence is compared below to registries around the globe. 10) 11) 12) 13) In addition, there are currently 2 publications on CBA-PVI in the Korean population for comparison of procedural outcome, and both are single-center experiences. 14) 15) …”

“…Also, 20.7% of Korean patients had a history of AFL, which is observed in some 11) 12) but not all registry cohorts. 9) 10) 13) …”

“…The mean number of freeze applications per vein was 1.5±1.0, with a mean duration of 167±54 seconds per application, in line with contemporary dosing strategies for the Arctic Front Advance cryoballoon. 9) 12) 13) …”