A systematic review and meta‐analysis comparing second‐generation cryoballoon and contact force radiofrequency ablation for initial ablation of paroxysmal and persistent atrial fibrillation

Venkatesh Ravi; Abhushan Poudyal; Priyanjali Pulipati; Timothy R. Larsen; Kousik Krishnan; Richard G. Trohman; Parikshit S. Sharma; Henry D. Huang

doi:10.1111/jce.14676

July 16, 2020Journal of Cardiovascular Electrophysiology

A systematic review and meta‐analysis comparing second‐generation cryoballoon and contact force radiofrequency ablation for initial ablation of paroxysmal and persistent atrial fibrillation

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Why the study?

Technological advances in cryoballoon ablation and radiofrequency ablation have improved procedural outcomes, warranting an updated comparison of their efficacy and safety in patients with AF.

Does second-generation cryoballoon ablation improve freedom from atrial arrhythmia compared to contact force radiofrequency ablation in patients undergoing initial ablation for atrial fibrillation?

Structured PICO

Does second-generation cryoballoon ablation improve freedom from atrial arrhythmia compared to contact force radiofrequency ablation in patients undergoing initial ablation for atrial fibrillation?

P

Population

17 studies involving 11,793 patients undergoing initial catheter ablation for paroxysmal and persistent atrial fibrillation.

I

Intervention

Second-generation cryoballoon ablation (CBA-2G)

C

Comparator

Contact force radiofrequency ablation (RFA-CF)

O

Outcome

Freedom from atrial arrhythmia and total procedural complications

Second-generation cryoballoon ablation and contact force radiofrequency ablation are equally efficacious for initial AF ablation, though CBA-2G offers shorter procedure times at the cost of higher phrenic nerve palsy risk.

Implication

Supports either CBA-2G or RFA-CF for initial AF ablation; extends evidence confirming comparable efficacy with distinct procedural trade-offs.

Abstract

INTRODUCTION: Cryoballoon ablation (CBA) and radiofrequency ablation (RFA) are the preferred modalities for catheter ablation of atrial fibrillation (AF). Technological advances have improved procedural outcomes, warranting an updated comparison. We sought to evaluate the efficacy and safety of CBA-2nd generation (CBA-2G) in comparison to RFA-contact force (RFA-CF) in patients with AF. METHODS: MEDLINE, Cochrane, and ClinicalTrials.gov databases were searched until 03/01/2020 for relevant studies comparing CBA-2G versus RFA-CF in patients undergoing initial catheter ablation for AF. RESULTS: A total of 17 studies, involving 11 793 patients were included. There was no difference between the two groups in the outcomes of freedom from atrial arrhythmia (p = .67) and total procedural complications (p = .65). There was a higher incidence of phrenic nerve palsy in CBA-2G (odds ratio: 10.7; 95% confidence interval [CI]: 5.85 to 19.55; p < .001). Procedure duration was shorter (mean difference: -31.32 min; 95% CI: -40.73 to -21.92; p < .001) and fluoroscopy duration was longer (+3.21 min; 95% CI: 1.09 to 5.33; p = .003) in CBA-2G compared to RFA-CF. In the subgroup analyses of patients with persistent AF and >1 freeze lesion delivered per vein, there was no difference in freedom from atrial arrhythmia. CONCLUSIONS: In AF patients undergoing initial ablation, CBA-2G and RFA-CF were equally efficacious. The procedure duration was shorter, but with a higher incidence of phrenic nerve palsy in CBA-2G. In patients with persistent AF, there was no difference in the efficacy between CBA-2G or RFA-CF techniques.