Key result
Cryoablation and RFA catheters show no difference in success or permanent block rates for AVNRT.
Why the study?
Periprocedural conduction system damage is a primary concern during AVNRT ablation, motivating an assessment of permanent AV block and success rates across different catheter types.
Do different types of ablation catheters (cryoablation or irrigated RFA) improve success rates or reduce permanent AV block compared to nonirrigated RFA in patients with AVNRT?
Meta-Analysis (n=5,110)
Do different types of ablation catheters (cryoablation or irrigated RFA) improve success rates or reduce permanent AV block compared to nonirrigated RFA in patients with AVNRT?
Effect estimate: OR 0.649 (95% CI 0.202-2.087)
Both radiofrequency ablation (irrigated and nonirrigated) and cryoablation (various tip sizes) are viable options for AVNRT ablation, demonstrating similar safety and efficacy profiles.
No differences support flexible catheter selection for AVNRT; confirms equivalence across cryoablation and RFA types.
INTRODUCTION: Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common supraventricular tachycardia referred for ablation. Periprocedural conduction system damage was a primary concern during AVNRT ablation. This study aimed to assess the incidence of permanent atrioventricular (AV) block and the success rate associated with different types of catheters in slow pathway ablation. METHOD: A literature search was performed to identify studies that compared various techniques, including types of radiofrequency ablation (irrigated and nonirrigated) and different sizes of catheter tip cryoablation (4, 6, and 8-mm), in terms of their outcomes related to permanent atrioventricular block and success rate. To assess and rank the treatments for the different outcomes, a random-effects model of network meta-analysis, along with p-scores, was employed. RESULTS: A total of 27 studies with 5110 patients were included in the analysis. Overall success rates ranged from 89.78% to 100%. Point estimation showed 4-mm cryoablation exhibited an odds ratio of 0.649 (95%CI: 0.202-2.087) when compared to nonirrigated RFA. Similarly, 6-mm cryoablation had an odds ratio of 0.944 (95%CI: 0.307-2.905), 8-mm cryoablation had an odds ratio of 0.848 (95%CI: 0.089-8.107), and irrigated RFA had an odds ratio of 0.424 (95%CI: 0.058-3.121) compared to nonirrigated RFA. CONCLUSION: Our study found no significant difference in the incidence of permanent AV block between the types of catheters. The success rates were consistently high across all groups. These findings emphasize the potential of both RF ablation (irrigated and nonirrigated catheter) and cryoablation as viable options for the treatment of AVNRT, with similar safety and efficacy profile.
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Siranart et al. (2024) conducted a meta-analysis in Atrioventricular nodal reentrant tachycardia (AVNRT) (n=5,110). Cryoablation (4-mm, 6-mm, 8-mm) and irrigated radiofrequency ablation vs. Nonirrigated radiofrequency ablation was evaluated on Incidence of permanent atrioventricular block and success rate (OR 0.649, 95% CI 0.202-2.087). Different types of radiofrequency ablation and cryoablation catheters for AVNRT showed no significant differences in outcomes (e.g., 4-mm cryoablation vs nonirrigated RFA OR 0.649; 95% CI 0.202-2.087).
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