Multi-catheter cryotherapy restored sinus rhythm acutely more often than radiofrequency ablation, but long-term sinus rhythm maintenance was similar (33% vs 24%).
RCT (n=100)
1:1
Does multi-catheter cryotherapy improve termination to sinus rhythm by ablation alone compared to radiofrequency ablation in patients with long-standing persistent atrial fibrillation?
Multi-catheter cryotherapy achieves higher rates of acute sinus rhythm restoration and shorter procedure times than RF ablation in persistent AF, but long-term arrhythmia recurrence rates remain similar.
Absolute Event Rate: 33% vs 24%
AIMS: Restoring sinus rhythm (SR) by ablation alone is an endpoint used in radiofrequency (RF) ablation for long-standing persistent atrial fibrillation (AF) but not with cryotherapy. The simultaneous use of two cryotherapy catheters can improve ablation efficiency; we compared this with RF ablation in chronic persistent AF aiming for termination to SR by ablation alone. METHODS AND RESULTS: Consecutive patients undergoing their first ablation for persistent AF of >6 months duration were screened. A total of 100 participants were randomized 1:1 to multi-catheter cryotherapy or RF. For cryotherapy, a 28-mm Arctic Front Advance was used in tandem with focal cryoablation catheters. Open-irrigated, non-force sensing catheters were used in the RF group with a 3D mapping system. Pulmonary vein (PV) isolation and non-PV triggers were targeted. Participants were followed up at 6 and 12 months, then yearly. Acute PVI was achieved in all cases. More patients in the multi-catheter cryotherapy group were restored to SR by ablation alone, with a shorter procedure duration. Sinus rhythm continued to the last available follow-up in 16/49 patients (33%) in the multi-catheter at 3.0 ± 1.6 years post-ablation and in 12/50 patients (24%) in the RF group at 4.0 ± 1.2 years post-ablation. The yearly rate of arrhythmia recurrence was similar. CONCLUSION: Multi-catheter cryotherapy can restore SR by ablation alone in more cases and more quickly than RF ablation. Long-term success is difficult to achieve by either methods and is similar with both.
Gallagher et al. (Fri,) conducted a rct in long-standing persistent atrial fibrillation (n=100). Multi-catheter cryotherapy vs. Radiofrequency ablation was evaluated on Sinus rhythm continued to the last available follow-up. Multi-catheter cryotherapy restored sinus rhythm acutely more often than radiofrequency ablation, but long-term sinus rhythm maintenance was similar (33% vs 24%).