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Comparison of cryoballoon and radiofrequency ablation for persistent atrial fibrillation: a systematic review and meta-analysis

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Abstract

Background

There is limited data comparing radiofrequency (RF) and cryoballoon (CB) ablation for persistent atrial fibrillation (AF), which tends to have higher recurrence rates following ablation compared to paroxysmal AF.

Methods

A systematic search of the Embase, PubMed, and Cochrane database was performed for studies comparing RF vs CB ablation for persistent AF. An inverse-variance random-effects model was used to calculate the composite effects.

Results

One randomized and 9 observational studies were identified, with 1650 patients receiving CB and 1706 patients receiving RF ablation. Mean follow-up time ranged from 12 to 48 months. Freedom from recurrent atrial tachyarrhythmia was similar with the two modalities (HR 0.93, 95% CI 0.80 to 1.08, I2 0%). Total complications were similar in both groups (RR 1.05, 95% CI 0.73 to 1.53, I2 0%) although rates of phrenic nerve palsy (PNP) were greater with CB (RR 4.13, 95% CI 1.49 to 11.46, I2 0%). Shorter procedure times were observed with CB (mean reduction 43.77 min, 95% CI 66.45 to 21.09 min, I2 96%) with no difference in fluoroscopy time (mean difference 0.82 min, 95% CI − 11.92 to 13.55 min, I2 100%).

Conclusions

In persistent AF patients, CB ablation has similar efficacy and overall safety as compared to RF ablation. While CB is associated with significantly shorter procedure times, the improved procedural efficiency with CB is offset by increased rates of PNP and the potential need for touch-up RF ablation.

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Abbreviations

AF:

Atrial fibrillation

ATA:

Atrial tachyarrhythmia

CB:

Cryoballoon

CF:

Contact force

PNP:

Phrenic nerve palsy

PVI:

Pulmonary vein isolation

RF:

Radiofrequency

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Authors and Affiliations

  1. Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA

    Jitae A. Kim

  2. Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA

    Mihail G. Chelu

  3. Baylor St. Luke’s Medical Center, Houston, TX, USA

    Mihail G. Chelu

  4. Texas Heart Institute, Houston, TX, USA

    Mihail G. Chelu

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Contributions

JK developed the idea for the study and designed the analysis. JK and MC contributed to data collection and writing of the final manuscript.

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Correspondence to Mihail G. Chelu.

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Kim, J.A., Chelu, M.G. Comparison of cryoballoon and radiofrequency ablation for persistent atrial fibrillation: a systematic review and meta-analysis. J Interv Card Electrophysiol 66, 585–595 (2023). https://doi.org/10.1007/s10840-022-01369-9

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  • DOI: https://doi.org/10.1007/s10840-022-01369-9

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