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July 27, 2022PLoS ONEOpen Access

Cryoballoon ablation showed comparable 12-month atrial tachyarrhythmia-free survival compared to radiofrequency catheter ablation in the overall cohort (72.7% vs 80.6%; HR 1.36, p=0.123).

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Why the study?

While cryoballoon ablation is established for paroxysmal AF, its role in persistent AF remains unclear.

Does cryoballoon ablation reduce the recurrence of atrial tachyarrhythmias in patients with symptomatic paroxysmal and persistent atrial fibrillation compared to radiofrequency catheter ablation?

Comparison

Cryoballoon ablation vs radiofrequency catheter ablation

Design

Retrospective study

Follow-up

12 months

Key result

Cryoballoon ablation showed comparable 12-month atrial tachyarrhythmia-free survival compared to radiofrequency catheter ablation in the overall cohort (72.7% vs 80.6%; HR 1.36, p=0.123).

Authors

JCJi‐Hoon ChoiSPSeung‐Jung ParkKPKyoung‐Min Park

Discussion

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Overview

Either technique remains a reasonable option in current practice; leaves open confirmation of equivalence in prospective studies.

Study Design

Type

Cohort (n=410)

Multicenter

No

Structured PICO

Does cryoballoon ablation reduce the recurrence of atrial tachyarrhythmias in patients with symptomatic paroxysmal and persistent atrial fibrillation compared to radiofrequency catheter ablation?

P
Population
410 adults with symptomatic paroxysmal or persistent atrial fibrillation who failed antiarrhythmic drugs, followed for a mean of 361 to 510 days.
E
Exposure
Cryoballoon ablation (second-generation, 28-mm) for pulmonary vein isolation.
C
Comparator
Radiofrequency catheter ablation (RFCA) guided by a 3D navigation system.
O
Outcome
Recurrence of any atrial tachyarrhythmias (atrial fibrillation, atrial flutter, or atrial tachycardia) after the index ablation at 12 months follow-up.composite

Main Result

Hazard Ratio: 1.36 (95% CI 0.91–2.04)

Absolute Event Rate: 72.7% vs 80.6%

p-value: p=0.123

Cryoballoon ablation offers comparable efficacy to radiofrequency catheter ablation for paroxysmal atrial fibrillation but is less effective for maintaining sinus rhythm in persistent atrial fibrillation.

Limitations

  • Non-randomized, single-center study with a relatively short follow-up time
  • Small number of patients with persistent atrial fibrillation
  • Atrial tachyarrhythmia recurrence might have been underestimated due to reliance on intermittent monitoring (Holter, event recorder, 12-lead ECG) rather than continuous monitoring
  • Ablation strategies in persistent atrial fibrillation differed between the ablation modalities

Cite This Study

Choi et al. (2022) conducted a cohort in Symptomatic paroxysmal and persistent atrial fibrillation (n=410). Cryoballoon ablation vs. Radiofrequency catheter ablation (RFCA) was evaluated on Freedom from any atrial tachyarrhythmias (ATas) at 12 months (HR 1.36, 95% CI 0.91-2.04, p=0.123). Cryoballoon ablation showed comparable 12-month atrial tachyarrhythmia-free survival compared to radiofrequency catheter ablation in the overall cohort (72.7% vs 80.6%; HR 1.36, p=0.123).

synapsesocial.com/papers/6a7ee203366dd125a6c307afhttps://doi.org/10.1371/journal.pone.0265482
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