Key result
HPSD RF ablation yields a ~5-point smaller isolation area ratio than cryoballoon ablation with similar efficacy.
Why the study?
To compare left atrial lesion size, function, and tissue damage following pulmonary vein isolation using high-power short-duration radiofrequency versus second-generation cryoballoon ablation.
Does high-power short-duration radiofrequency ablation compared to second-generation cryoballoon ablation alter left atrial isolation lesion size, myocardial injury biomarkers, and left atrial mechanical function in patients with paroxysmal atrial fibrillation?
RCT (n=40)
Blinded outcome assessment (CTA image processing blinded to PVI strategy)
Randomly assigned to either RF or CB2 ablation
No
Does high-power short-duration radiofrequency ablation compared to second-generation cryoballoon ablation alter left atrial isolation lesion size, myocardial injury biomarkers, and left atrial mechanical function in patients with paroxysmal atrial fibrillation?
Compared with 28-mm second-generation cryoballoon ablation, CLOSE-protocol guided HPSD radiofrequency ablation creates a more focal left atrial isolation area with higher specific myocardial troponin release but lower systemic inflammation/collateral injury (hs-CRP and LDH) and reduced fluoroscopy exposure, while equally preserving left atrial mechanical function.
Answers are grounded in this paper and cite their sources.
HPSD RF ablation offers comparable efficacy with more focal lesions than cryoballoon; extends RCT data guiding technique selection in paroxysmal AF.
This randomized study aims to compare the left atrial (LA) lesion size, function, and tissue damage following pulmonary vein isolation (PVI) by high-power short-duration (HPSD) radiofrequency (RF) and second-generation cryoballoon (CB2) ablation. We enrolled 40 patients with paroxysmal atrial fibrillation who underwent PVI by HPSD RF (n = 21) or CB2 (n = 19). Every patient underwent LA CT angiography and transthoracic echocardiography (TTE) to assess the LA anatomy and function. Biomarker levels (hs-cTnT, hs-CRP, LDH) were compared pre- and post-procedurally. Pre- and post-ablation high-density mapping (HDM) was performed. The isolation area was defined under 0.2 mV bipolar voltage (low voltage area, LVA). We calculated the post-PVI LVA/LA surface ratio using LA CT-HDM merge images. At 3-month follow-up, TTE was performed to assess the changes in LA function. Post-ablation hs-cTnT level was significantly higher in the RF group (RF: 1249 ± 469 ng/L, CB2: 995 ± 280 ng/L, p = 0.024). Post-PVI hs-CRP (RF: 9.53 ± 10.30 mg/L, CB2: 12.36 ± 5.76 mg/L, p = 0.034) and LDH levels (RF: 349.9 ± 65.6 U/L, CB2: 451.6 ± 91.3 U/L, p < 0.001) were significantly higher following CB2 ablation. Post-PVI LVA/LA surface ratios were 8.37 ± 6.42% in the RF group and 13.58 ± 8.92% in the CB2 group (p = 0.022). LA function did not change significantly after the PVI procedure. Our data indicate that second-generation cryoballoon ablation produces a significantly larger LA lesion size compared to “point-by-point” HPSD radiofrequency. Both techniques preserve LA function. The myocardial component of tissue loss appears to be higher using HPSD radiofrequency ablation, with less collateral damage.
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Kássa et al. (2022) conducted an RCT in Symptomatic, drug-refractory paroxysmal atrial fibrillation (n=40). High-power short-duration (HPSD) radiofrequency ablation vs. Second-generation cryoballoon (CB2) ablation (28 mm, 180-240 s freezing strategy) was evaluated on Post-PVI low voltage area (<0.2 mV) to left atrial surface ratio (LVA/LA surface ratio) (p=0.022). High-power short-duration RF ablation produced a smaller isolation area ratio than cryoballoon ablation (8.37% vs 13.58%, p=0.022) with higher hs-cTnT release (p=0.024) and similar 18-month efficacy.
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