Key result
Hot balloon ablation for atrial fibrillation was associated with a significantly higher incidence of touch-up ablation (OR 2.76) and longer procedure time compared to cryoballoon ablation.
Why the study?
Differences in characteristics, effectiveness, safety, and efficacy between hot balloon ablation and cryoballoon ablation for atrial fibrillation remain undetermined.
Does hot balloon ablation improve procedural characteristics or clinical outcomes compared to cryoballoon ablation in patients with atrial fibrillation?
Meta-Analysis (n=679)
Does hot balloon ablation improve procedural characteristics or clinical outcomes compared to cryoballoon ablation in patients with atrial fibrillation?
While hot balloon ablation and cryoballoon ablation have comparable mid-term clinical outcomes for AF, hot balloon ablation requires more frequent touch-up ablation and longer procedure times.
Hot balloon ablation increases touch-up needs and procedure time; supports cryoballoon preference for procedural efficiency in AF.
Background: Balloon-based catheter ablations, including hot balloon ablation (HBA) and cryoballoon ablation (CBA), have rapidly emerged as alternative modalities to conventional catheter atrial fibrillation (AF) ablation owing to their impressive procedural advantages and better clinical outcomes and safety. However, the differences in characteristics, effectiveness, safety, and efficacy between HBA and CBA remain undetermined. This study compares the characteristic and prognosis differences between HBA and CBA. Methods: Electronic search was conducted in six databases (PubMed, Embase, Cochrane Library, Web of Science, ClinicalTrial.gov, and medRxiv) with specific search strategies. Eligible studies were selected based on specific criteria; all records were identified up to June 1, 2021. The mean difference, odds ratios (ORs), and 95% confidence intervals (CIs) were calculated to evaluate the clinical outcomes. Heterogeneity and risk of bias were assessed using predefined criteria. Results: Seven studies were included in the final meta-analysis. Compared with CBA, more patients in the HBA group had residual conduction and required a higher incidence of touch-up ablation (TUA) [OR (95% CI) = 2.76 (2.02–3.77), P = 0.000]. The most frequent sites of TUA were the left superior pulmonary veins (PVs) in the HBA group vs. the right inferior PVs in the CBA group. During HBA surgery, the left and right superior PVs were more likely to have a higher fluid injection volume. Furthermore, the procedure time was longer in the HBA group than in the CBA group [weighted mean difference (95% CI) = 14.24 (4.39–24.09), P = 0.005]. Patients in the CBA group could have an increased risk of AF occurrence, and accepted more antiarrhythmic drug therapy; however, the result was insignificant. Conclusions: HBA and CBA are practical ablation approaches for AF treatment. Patients who received HBA had a higher incidence of TUA and longer procedure time. Clinical outcomes during the mid-term follow-up between HBA and CBA were comparable. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=259487 , identifier: CRD42021259487.
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Peng et al. (2021) conducted a meta-analysis in Atrial Fibrillation (n=679). Hot Balloon Ablation (HBA) vs. Cryoballoon Ablation (CBA) was evaluated on Incidence of touch-up ablation (TUA) (OR 2.76, 95% CI 2.02-3.77, p=0.000). Hot balloon ablation for atrial fibrillation was associated with a significantly higher incidence of touch-up ablation (OR 2.76) and longer procedure time compared to cryoballoon ablation.
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