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Cryoballoon vs radiofrequency ablation of atrial fibrillation: insights from the Veterans Healthcare System

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Catheter ablation is considered the mainstay treatment for drug-refractory atrial fibrillation (AF). The aims of our study were to compare the efficacy and safety of the most two currently approved approaches (point-by-point radiofrequency ablation (RFA), either with contact force (CF) or without contact force (nCF) catheters, and cryoballoon ablation (CBA)) in the Veterans Healthcare System.

Methods

We performed a retrospective study of patients who underwent ablation for treatment of AF at the veterans affairs healthcare system between 2013 and 2018. Only the first reported ablation procedure was included.

Results

We included 956 patients in the study (97.4% males, 91.5% Caucasians, 67% paroxysmal AF), with 682 patients in RFA-nCF, 139 in RFA-CF, and 135 in CBA. Thirty-day complication rates were comparable between the three groups with the exception of higher incidence of phrenic nerve injury in CBA group when compared to RFA-nCF (2.2% vs 0.0%, p < 0.01). Long-term recurrence rate of AF was significantly lower in the CBA group when compared to RFA-nCF (33.3% vs 47.7%, adjusted HR 0.60, 95% CI 0.44–0.83, p < 0.01). On the other hand, it was similar between RFA-CF and RFA-nCF groups (43.9% vs 47.7%, adjusted HR 1.01, 95% CI 0.76–1.33, p 0.97). After stratifying patients based on AF type, these findings were only present in patients with paroxysmal AF.

Conclusion

CBA for paroxysmal AF, in male dominant patients’ population, was associated with lower incidence of AF recurrence rate while having a comparable safety profile to RFA independent of the use of CF catheters.

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Data Availability

Available upon reasonable request

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Author information

Author notes

  1. Waddah Maskoun and Amjad Abualsuod contributed equally to this work.

Authors and Affiliations

  1. Section of Electrophysiology, Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA

    Waddah Maskoun

  2. Indiana University Health System, Indianapolis, IN, USA

    Amjad Abualsuod, Mohammed E. Madmani & John M. Miller

  3. University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Fuad Habash & Srikanth Vallurupalli

  4. Central of Arkansas Veterans Healthcare system, Little Rock, AR, USA

    Fuad Habash & Srikanth Vallurupalli

  5. Louisiana State University Shreveport, Shreveport, LA, USA

    Khaldia Khaled

  6. University of Kansas Medical Center, Kansas City, KS, USA

    Zaid Gheith

  7. Presbyterian Hospital, Albuquerque, NM, USA

    Bilal Alqam

Authors
  1. Waddah Maskoun
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Contributions

Waddah Maskoun: Conceptualization, methodology, original draft, review, and editing

Amjad Abualsuod: Data collection, statistical analysis, original draft, review, and editing

Fuad Habash: Material preparation, data collection, review, and editing.

Mohammed E. Madmani: Data collection, review, and editing.

Khaldia Khaled: Data collection, review, and editing.

Zaid Gheith: Data collection, review, and editing.

Bilal Alqam, MD: Data collection, review, and editing.

John M. Miller: Review and editing.

Srikanth Vallurupalli: Supervision, review, and editing

Corresponding author

Correspondence to Waddah Maskoun.

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Conflict of interest

W. Maskoun, Medtronic grant; J. Miller, Medtronic, Boston Scientific, Biosense-Webster, Biotronik, Abbott Electrophysiology—training grants and lecture honoraria. The remaining authors have nothing to disclose.

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Maskoun, W., Abualsuod, A., Habash, F. et al. Cryoballoon vs radiofrequency ablation of atrial fibrillation: insights from the Veterans Healthcare System. J Interv Card Electrophysiol 62, 531–538 (2021). https://doi.org/10.1007/s10840-020-00927-3

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  • DOI: https://doi.org/10.1007/s10840-020-00927-3

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