Key result
Cryoballoon ablation yields similar radiation exposure to radiofrequency ablation but shortens procedure duration.
Why the study?
With increasing numbers of RF and CB procedures for AF, radiation exposure and its reduction have become a key focus for electrophysiologists.
Does second-generation cryoballoon ablation reduce procedural time and radiation exposure compared to radiofrequency ablation in patients undergoing pulmonary vein isolation?
Cohort (n=1,133)
No
Does second-generation cryoballoon ablation reduce procedural time and radiation exposure compared to radiofrequency ablation in patients undergoing pulmonary vein isolation?
Second-generation cryoballoon ablation for pulmonary vein isolation is safe, requires shorter procedural times, and produces radiation exposure comparable to radiofrequency ablation.
CB2 ablation was associated with shorter PVI procedures and comparable DAP versus RF; leaves open generalizability pending randomized confirmation.
Background Facing an increasing number of radiofrequency ablation (RF) and cryoballoon ablation (CB) procedures for treatment of AF radiation exposure and its reduction is a focus point for interventional electrophysiologists. Objective This study evaluated the procedural parameters of the different ablation methods focusing on radiation exposure and the BMI of the patients. Methods One thousand one hundred and thirty‐three first procedural cases of pulmonary vein isolation in patients with paroxysmal and persistent AF treated with RF and CB‐based techniques were analyzed retrospectively over a period of 7 years focusing on the endpoints dose area product (DAP, cGycm 2 ), fluoroscopy time (FT, min) and procedural time (PT, min). Results Of the 1133 patients (mean age 63.4 ± 11.4 years, BMI 28.9 ± 4.7) 335 patients received an RF procedure, 211 patients were treated with the cryoballoon first generation (CB1), and 587 patients with cryoballoon second generation (CB2), respectively. The mean DAP for the PVI was 508 ± 654 cGycm 2 in RF procedures, 1077 ± 683 cGycm 2 in CB1‐procedures, and 587 ± 489 cGycm 2 in CB2‐procedures with fluoroscopy times significantly shorter in RF procedures (9.6 ± 5.2 min) as compared to 17.7 ± 5.9 min in CB1‐ and 16.3 ± 6.3 min in CB2‐procedures ( p < .001). At the same time, the procedure duration using RF (115 ± 33.5 min) was significantly longer than both in CB1 (96 ± 16.8 min) and CB2 procedures (75 ± 15.9 min). Conclusions Despite longer fluoroscopy durations in the CB technique, the CB2 resulted in a comparable low radiation exposure in PVI as compared to RF, accompanied by shorter procedure durations.
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Heinroth et al. (2022) conducted a cohort in Atrial Fibrillation (n=1,133). Cryoballoon second generation (CB2) vs. Radiofrequency ablation (RF) was evaluated on Dose area product (DAP, cGycm2) (p=0.509). Second-generation cryoballoon ablation for pulmonary vein isolation resulted in comparable dose area product (587 vs 508 cGycm2) and significantly shorter procedure durations compared to radiofrequency ablation.
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