Key result
Cryoballoon and high-power short-duration pulmonary vein isolation resulted in similar overall clinical recurrence rates compared to conventional radiofrequency ablation, though cryoballoon ablation reduced recurrence in paroxysmal atrial fibrillation (HR 0.57).
Why the study?
The comparative efficacy, safety, and heart rate variability parameters after pulmonary vein isolation using Cryo-PVI, HPSD-PVI, and conventional-PVI for AF were unclear.
Does pulmonary vein isolation using cryoballoon or high-power short-duration radiofrequency ablation improve recurrence rates compared to conventional radiofrequency ablation in patients with atrial fibrillation?
Cohort (n=3,395)
No
Does pulmonary vein isolation using cryoballoon or high-power short-duration radiofrequency ablation improve recurrence rates compared to conventional radiofrequency ablation in patients with atrial fibrillation?
Absolute Event Rate: 21.4% vs 24.5%
p-value: p=0.824
Cryoballoon pulmonary vein isolation is associated with better rhythm outcomes in paroxysmal AF but worse outcomes in persistent AF compared to conventional radiofrequency ablation.
Cryoballoon PVI was associated with lower paroxysmal AF recurrence; observational findings leave comparative efficacy open for randomized confirmation.
Background The comparative efficacy, saftey, and heart rate variability (HRV) parameters after pulmonary vein isolation using cryoballoon (Cryo-PVI), high-power short-duration (HPSD-PVI), and conventional radiofrequency ablation (conventional-PVI) for atrial fibrillation (AF) is unclear. Materials and methods In this propensity score-weighted, retrospective analysis of a single-center cohort, we analyzed 3,395 patients (26.2% female, 74.5% paroxysmal AF) who underwent AF catheter ablation without an empirical left atrial ablation. Procedural factors, recurrence rates, complication rates, and the post-procedural HRV parameters were compared across the Cryo-PVI ( n = 625), HPSD-PVI ( n = 748), and conventional-PVI ( n = 2,022) groups. Results Despite the shortest procedural time in the Cryo-PVI group (74 min for Cryo-PVI vs. 104 min for HPSD-PVI vs. 153 min for conventional-PVI, p < 0.001), the major complication ( p = 0.906) and clinical recurrence rates were similar across the three ablation groups (weighted log-rank, p = 0.824). However, the Cryo-PVI group was associated with a significantly lower risk of recurrent AF in patients with paroxysmal AF [weighted hazard ratio (WHR) 0.57, 95% confidence interval (CI) 0.37–0.86], whereas it was associated with a higher risk of recurrent AF in patients with persistent AF (WHR 1.41, 95% CI 1.06–1.89, p for interaction of <0.001) compared with the conventional-PVI group. In the subgroup analysis for the HRV, the Cryo-PVI group had the highest low-frequency-to-high-frequency ratio at 1-year post-procedure, whereas the HPSD-PVI group had the lowest low-frequency-to-high-frequency ratio at 1-year post-procedure ( p < 0.001). Conclusions The Cryo-PVI group had better rhythm outcomes in patients with paroxysmal AF but worse rhythm outcomes in patients with persistent AF and a higher long-term post-procedural sympathetic nervous activity and sympatho-vagal balance compared with the conventional-PVI group.
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Park et al. (2023) conducted a cohort in Atrial fibrillation (n=3,395). Cryoballoon pulmonary vein isolation (Cryo-PVI) and high-power short-duration pulmonary vein isolation (HPSD-PVI) vs. Conventional radiofrequency ablation (conventional-PVI) was evaluated on Clinical recurrence of atrial fibrillation (>3 months post-procedure) (p=0.824). Cryoballoon and high-power short-duration pulmonary vein isolation resulted in similar overall clinical recurrence rates compared to conventional radiofrequency ablation, though cryoballoon ablation reduced recurrence in paroxysmal atrial fibrillation (HR 0.57).
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