Key result
Cryoballoon AF ablation achieves ~64% freedom from arrhythmia in HF patients, matching non-HF recurrence risk.
Why the study?
While AF ablation is beneficial for HF patients, most evidence derived from radiofrequency ablation, leaving the efficacy and safety of cryoballoon ablation in HFrEF less defined.
Does cryoballoon atrial fibrillation ablation improve freedom from atrial arrhythmia, LVEF, and NYHA class in patients with heart failure?
Meta-Analysis (n=1,414)
Does cryoballoon atrial fibrillation ablation improve freedom from atrial arrhythmia, LVEF, and NYHA class in patients with heart failure?
Effect estimate: RR 1.34 (95% CI 0.8-2.23)
Cryoballoon ablation for atrial fibrillation in patients with heart failure is effective, significantly improves LVEF, and has a low complication rate.
Supports cryoballoon ablation as viable AF strategy in heart failure; extends evidence with LVEF gains and comparable efficacy.
While atrial fibrillation (AF) ablation has proven beneficial for heart failure (HF) patients, most reports were performed with radiofrequency ablation. We aimed to evaluate the efficacy and safety of cryoballoon AF ablation in patients with HFrEF. We comprehensively searched the databases of MEDLINE, EMBASE, and Cochrane database from inception to December 2022. Studies that reported the outcomes of freedom from atrial arrhythmia, complications, NYHA functional class (NYHA FC), and left ventricular ejection fraction (LVEF) after Cryoballoon AF ablation in HF patients were included. Data from each study were combined with a random-effects model. A total of 9 studies observational studies with 1414 HF patients were included. Five studies had only HF with reduced ejection fraction (HFrEF), 1 study with HF with preserved ejection fraction (HFpEF), and others with mixed HF types. Freedom from AA in HFrEF at 12 months was 64% (95% CI 56–71%, I2 58%). There was a significant improvement of LVEF in these patients with a standard mean difference of 13% (95% CI 8.6–17.5%, I2 99% P < 0.001. The complication rate in HFrEF group was 6% (95% CI 4–10%, I2 0%). The risk of recurrence of atrial arrhythmia was not significantly different between HF and no HF patients (RR 1.34, 95% CI 0.8–2.23, I2 76%). Cryoballoon AF ablation is effective in HFrEF patients comparable to radiofrequency ablation. The complication rate was low.
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Tokavanich et al. (2024) conducted a meta-analysis in Atrial fibrillation and heart failure (n=1,414). Cryoballoon atrial fibrillation ablation vs. Patients without heart failure was evaluated on Recurrence of atrial arrhythmia (HF vs no HF patients) (RR 1.34, 95% CI 0.8-2.23). Cryoballoon AF ablation in heart failure patients achieved 64% freedom from atrial arrhythmia at 12 months, with recurrence risk similar to patients without heart failure (RR 1.34; 95% CI 0.8-2.23).
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