Elsevier

The American Journal of Cardiology

Volume 184, 1 December 2022, Pages 22-30
The American Journal of Cardiology

Comparative Effectiveness and Safety of Cryoablation Versus Radiofrequency Ablation Treatments for Persistent Atrial Fibrillation

https://doi.org/10.1016/j.amjcard.2022.08.031Get rights and content

The purpose of this study was to compare the effectiveness and safety of 2 strategies for catheter treatment of patients with persistent atrial fibrillation in the long-term period, using cardiac implantable loop recorders. The research is a prospective, randomized, controlled study designed to compare the results of modern catheter technologies in patients with persistent atrial fibrillation. The study included 127 patients with persistent atrial fibrillation in the last 6 months before inclusion in the study, for whom at least 2 antiarrhythmic drugs of class I to III were not effective. By random distribution, 50 patients were included in group 1; they underwent cryoballoon ablation, using a cryoballoon of the second generation. Group 2 also included 50 patients who underwent radiofrequency ablation, where a catheter was used to control the contact force. Cardiac implantable loop electrocardiogram recorders were implanted in all patients after surgery. The average duration of follow-up was 36 months. The primary end point of efficacy occurred in 15 patients in the group with cryoballoon ablation and 14 patients in the group with radiofrequency ablation. In conclusion, the primary effectiveness was relatively the same in the groups; yet, in the long-term period, the superiority of radiofrequency ablation using catheters with pressure control was noted, but the difference in results was statistically insignificant (p <0.672) and there was no significant difference between the 2 methods in terms of overall safety.

Introduction

The cornerstone in the catheter treatment of atrial fibrillation (AF) is pulmonary vein (PV) isolation.1,2 Over the past few decades, all catheter technologies have been aimed specifically at PV isolation, and standard catheter radiofrequency ablation (RFA), based on sequential “point-by-point” applications, and later developed (“single-shot” technology) cryoballoon ablation (CBA).3, 4, 5, 6, 7 In large observational studies, acceptable success rates with a low level of adverse events were reported in paroxysmal forms of AF.8, 9, 10, 11 Previous studies (which were mainly conducted in patients with paroxysmal AF) comparing the effectiveness and safety of these 2 methods showed statistical equivalence between the 2 technologies.12, 13, 14, 15 The FreezeAF study showed a better safety profile in the RFA group, and in the CBA group, there were more episodes of phrenic nerve injury. However, the FreezeAF analysis included episodes of phrenic nerve injury that resolved before discharge, and in most cases, a first-generation balloon was used.16 In studies like “Fire & Ice” that compared the effectiveness of cryoballoon isolation of PVs and radiofrequency catheter isolation of PV, there were no statistically significant differences in the results of ablation (freedom of arrhythmia in 88% and 92% after 1 or 2 procedures, with a follow-up period of 33 months).17

Section snippets

Methods

The study was approved by the local ethics committee of the Syzganov National Scientific Centre of Surgery. The research is a prospective, randomized, controlled study designed to compare the results of modern catheter technologies (RFA and CBA) in patients with a persistent form of AF. The design of the study (Figure 1) was approved by the ethics committee at the Syzganov National Scientific Centre of Surgery.

The study included patients with persistent AF in the last 6 months before inclusion

Results

In 50 patients who were randomized to ablation, 198 PVs were isolated in 1 procedure. In 48 patients (96%), ≥3 PVs were isolated, which was confirmed by the entrance and/or exit block. All 4 main PVs were isolated in 46 patients (92%), and 7 of 7 left collectors (LCPV); all patients underwent only CBA and it was enough for complete isolation, and only 6 ± 2 applications were required for all PVs. The average application time of the cryoballoon was 225 ± 15 seconds. The cryoablation temperature

Discussion

This study provides a comparative assessment of the effectiveness, safety, and procedural profiles of the 2 most commonly used technologies. The clinical characteristics of the patients were similar in both treatment groups. The primary effectiveness was relatively the same in the groups; however, in the long-term period, the superiority of RFA with the use of pressure control catheters was noted, but the difference in results was statistically insignificant (p <0.672) (Figure 4). There was

Disclosures

The authors have no conflicts of interest to declare.

References (24)

  • W Su et al.

    Cryoballoon best practices II: practical guide to procedural monitoring and dosing during atrial fibrillation ablation from the perspective of experienced users

    Heart Rhythm

    (2018)
  • KRJ Chun et al.

    Complications in catheter ablation of atrial fibrillation in 3,000 consecutive procedures: balloon versus radiofrequency current ablation

    JACC Clin Electrophysiol

    (2017)
  • M Haïssaguerre et al.

    Electrophysiological end point for catheter ablation of atrial fibrillation initiated from multiple pulmonary venous foci

    Circulation

    (2000)
  • A Revishvili et al.

    Long-term results of interventional treatment of atrial fibrillation

    J Arrhythmol

    (2012)
  • A Verma et al.

    Approaches to catheter ablation for persistent atrial fibrillation

    N Engl J Med

    (2015)
  • KH Kuck et al.

    FIRE AND ICE Investigators. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation

    N Engl J Med

    (2016)
  • AK Baimbetov et al.

    Prediction of arrhythmia recurrence after atrial fibrillation ablation in patients with normal anatomy of the left atrium

    Int J Clin Pract

    (2021)
  • A Baimbetov et al.

    Long-term results of simultaneous hybrid ablation of therapy-resistant atrial fibrillation

    Eur Heart J

    (2020)
  • A Fürnkranz et al.

    Rationale and design of fire and ice: a multicenter randomized trial comparing efficacy and safety of pulmonary vein isolation using a cryoballoon versus radiofrequency ablation with 3d-reconstruction

    J Cardiovasc Electrophysiol

    (2014)
  • F Ouyang et al.

    Long-term results of catheter ablation in paroxysmal atrial fibrillation: lessons from a 5-year follow-up

    Circulation

    (2010)
  • E Pokushalov et al.

    Cryoballoon versus radiofrequency for pulmonary vein re-isolation after a failed initial ablation procedure in patients with paroxysmal atrial fibrillation

    J Cardiovasc Electrophysiol

    (2013)
  • AJ Camm et al.

    Guidelines (CPG). 2012 Focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association

    Eur Heart J

    (2012)
  • View full text