Radiofrequency versus cryoballoon ablation for the treatment of atrial fibrillation: a comprehensive systematic review and meta-analysis of randomized controlled trials

Background Determining the safer and more effective ablation technique for atrial fibrillation (AF) remains a matter of concern. Thus, in this meta-analysis, we evaluated radiofrequency ablation (RFA) and cryoballoon ablation (CA) through randomized controlled trials (RCTs) comparing the two techniques in terms of freedom from AF, any tachyarrhythmia recurrence, procedure duration, and mortality. Methods A PubMed, Scopus, Web of Science, and Cochrane literature search was conducted from inception until December 2024. RCTs comparing RFA versus CA for AF were included. All relevant outcomes were pooled in the meta-analysis using Review Manager Software. Categorical outcomes were compared through the relative risk (RR) and confidence interval (CI) while continuous outcomes were compared using the mean difference (MD) and standard deviation (SD). Results We included 23 RCTs with a total of 3018 patients. Both types of ablations were comparable regarding freedom from AF and recurrence of any atrial tachyarrhythmias (RR = 0.99, 95% CI (0.90, 1.09), P = 0.90; RR = 0.94, 95% CI (0.82, 1.08), P =0.38, respectively) (Fig-1A and B). Regarding safety, PNP was significantly lower with RF (RR = 0.36, 95% CI (0.24, 0.54), P < 0.00001) (Fig-2A). However, the procedure was significantly longer than CA (MD = 17.91, 95% CI (7.85, 27.98), P = 0.0005) (Fig-2B). Conclusion RFA and CA have comparable efficacy outcomes for rhythm control in AF but have unique procedural and safety profiles. The choice between these modalities should be guided by clinical context, operator expertise, and patient-specific considerations. Further research, particularly in high-risk populations and with evolving ablation technologies, is essential to refine these insights and optimize patient outcomes.