Comparative Effectiveness and Safety of Cryoablation Versus Radiofrequency Ablation Treatments for Persistent Atrial Fibrillation
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.
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Radiofrequency versus cryoballoon catheter ablation in patients with persistent atrial fibrillation: A randomized trial
2023, Journal of Cardiovascular Electrophysiology