First-line cryoballoon ablation for paroxysmal atrial fibrillation resulted in 71% freedom from AF/AT at 1.4 years compared to 61% with radiofrequency ablation (P=0.11).
Cohort (n=373)
Does cryoballoon ablation improve freedom from AF/atrial tachycardia compared to radiofrequency ablation in treatment-naïve patients with paroxysmal atrial fibrillation?
First-line ablation for paroxysmal AF is safe and effective with either radiofrequency or cryoballoon, with no significant difference in freedom from AF/AT at 1.4 years, though cryoballoon had shorter procedure times and higher radiation exposure.
Absolute Event Rate: 71% vs 61%
p-value: p=0.11
AIMS: First-line ablation prior to antiarrhythmic drug (AAD) therapy is an option for symptomatic paroxysmal atrial fibrillation (PAF); however, the optimal ablation technique, radiofrequency (RF), or cryoballoon (CB) has to be determined. METHODS AND RESULTS: The FREEZE Cohort Study compares RF and CB ablation. Treatment-naïve patients were documented in the FREEZEplus Registry. Periprocedural data and outcome were analysed. From 2011 to 2014, a total of 373/4184 (8.9%) patients with PAF naïve to AAD were identified. Pulmonary vein isolation (PVI) was performed with RF (n = 180) or CB (n = 193). In the RF group, patients were older (65 vs. 61 years, P < 0.01) compared with the CB group. The procedure time was significantly shorter and radiation exposure higher in the CB group. Major adverse events occurred in 1.6% (CB) and 3.7% (RF) of patients (P = 0.22). AF/atrial tachycardia (AT) recurrence until discharge was 4.5% (RF) and 8.5% (CB, P = 0.2). Follow-up (FU) ≥12 months was available in 99 (RF) and 107 (CB) patients. After 1.4 years of FU, freedom from AF/atrial tachycardia (AT) was 61% (RF) and 71% (CB, P = 0.11). In the RF group, more patients underwent cardioversion, and a trend for more repeat ablations was observed. Persistent phrenic nerve palsy was observed in one patient treated by CB. CONCLUSION: First-line ablation for PAF is safe and effective with either RF or CB. The procedure was faster with the CB, but the radiation exposure was higher. Although there was a trend for more recurrences and complications in the RF group, a more favourable risk profile in patients undergoing CB ablation might have biased the results. CLINICALTRIALSGOV IDENTIFIER: NCT01360008.
Straube et al. (Sun,) conducted a cohort in paroxysmal atrial fibrillation (n=373). Cryoballoon (CB) ablation vs. Radiofrequency (RF) ablation was evaluated on Freedom from AF/atrial tachycardia (AT) (p=0.11). First-line cryoballoon ablation for paroxysmal atrial fibrillation resulted in 71% freedom from AF/AT at 1.4 years compared to 61% with radiofrequency ablation (P=0.11).