Key result
Cryoballoon ablation matches radiofrequency ablation for 1-year atrial tachyarrhythmia recurrence.
Why the study?
There are limited prospective data on the efficacy, safety, and impact on reverse remodelling of cryoballoon ablation compared to radiofrequency ablation for persistent atrial fibrillation.
Does cryoballoon ablation prevent atrial tachyarrhythmias compared to radiofrequency ablation in patients with persistent atrial fibrillation?
RCT (n=500)
randomized
Yes
Does cryoballoon ablation prevent atrial tachyarrhythmias compared to radiofrequency ablation in patients with persistent atrial fibrillation?
Cryoballoon ablation is an effective and non-inferior alternative to radiofrequency ablation for maintaining sinus rhythm at 1 year in patients with persistent atrial fibrillation, although radiofrequency ablation may offer greater reverse left atrial remodeling.
Answers are grounded in this paper and cite their sources.
Supports cryoballoon ablation as an alternative for persistent AF rhythm control; extends randomized evidence to this population.
BACKGROUND AND AIMS: There are limited prospective data on the efficacy, safety, and impact on reverse remodelling of cryoballoon ablation as compared to radiofrequency ablation for persistent atrial fibrillation. METHODS: A prospective, multicentre, randomized, non-inferiority clinical trial was conducted to compare the efficacy and safety of cryoballoon vs radiofrequency ablation for persistent atrial fibrillation. A total of 500 patients with persistent atrial fibrillation were randomized across 12 centres. The primary endpoint was the occurrence of atrial tachyarrhythmias at 1 year with a 90-day blanking period after ablation. RESULTS: The final analysis included 499 patients, with a median age of 69 years (interquartile range, 61-74); 249 patients were allocated to the cryoballoon group, and 250 to the radiofrequency group. In the intention-to-treat analysis, the primary endpoint was observed in 56 patients (22.5%) in the cryoballoon group and 58 (23.2%) in the radiofrequency group, and the cryoballoon group demonstrated non-inferiority compared to the radiofrequency group for the primary endpoint (hazard ratio .99; 95% confidence interval, .69-1.43; P = .96). The radiofrequency group showed a greater reduction in left atrial size (left atrial volume index) at 1 year than the cryoballoon group [-11 mL/m2 (interquartile range, -19 to -4) vs -4 mL/m2 (interquartile range, -13 to 3), P < .001]. CONCLUSIONS: In this randomized trial, cryoballoon ablation was non-inferior to radiofrequency ablation for the occurrence of atrial tachyarrhythmias at 1 year in patients with persistent atrial fibrillation.
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Miyamoto et al. (2025) conducted an RCT in persistent atrial fibrillation (n=500). Cryoballoon ablation vs. Radiofrequency ablation was evaluated on occurrence of atrial tachyarrhythmias at 1 year with a 90-day blanking period after ablation (HR 0.99, 95% CI 0.69-1.43, p=.96). Cryoballoon ablation was non-inferior to radiofrequency ablation for the occurrence of atrial tachyarrhythmias at 1 year (22.5% vs 23.2%; HR 0.99; 95% CI 0.69-1.43; P=0.96).
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