Why the study?
Limited comparative data were available regarding catheter ablation of AF using second-generation cryoballoon versus radiofrequency ablation in elderly patients (>75-year-old).
Does second-generation cryoballoon ablation improve procedural and clinical outcomes compared to radiofrequency ablation in elderly patients (>75 years) with symptomatic drug-refractory atrial fibrillation?
Does second-generation cryoballoon ablation improve procedural and clinical outcomes compared to radiofrequency ablation in elderly patients (>75 years) with symptomatic drug-refractory atrial fibrillation?
In elderly patients with atrial fibrillation, second-generation cryoballoon ablation offers shorter procedure times and lower early recurrence rates than radiofrequency ablation, though with higher costs and fluoroscopy times, while maintaining similar long-term efficacy and safety.
May favor CB-2 for procedural efficiency in elderly AF; leaves open need for RCTs to confirm outcomes.
BACKGROUND: Limited comparative data are available regarding catheter ablation (CA) of atrial fibrillation (AF) using second-generation cryoballoon (CB-2) vs radiofrequency (RF) ablation in elderly patients (>75-year-old). HYPOTHESIS: CB-2 ablation may demonstrate different outcomes compared with that using RF ablation for elderly patients with AF. METHOD: Elderly patients with symptomatic drug-refractory AF were included in the study. Pulmonary vein isolation was performed in all patients. RESULTS: A total of 324 elderly patients were included (RF: 176, CB-2:148) from September 2016 to April 2019. The CB-2 was associated with shorter procedure time and left atrial dwell time (112.9 ± 11.1 vs 135.1 ± 9.9 minutes, P < .001; 53.7 ± 8.9 vs 65.1.9 ± 9.0 minutes, P < .001), but marked fluoroscopy utilization (22.1 ± 3.3 vs 18.5 ± 3.6 minutes, P < .001). Complications occurred in 3.3% (CB-2) and 6.2% (RF) of patients with no significant different (P = .307). The length of stay after ablation was shorter, but the costs were higher in the CB-2 group (1.94 vs 2.53 days, P < .001 and 91 132.6 ± 3723.5 vs 81 149.4 ± 6824.1 CNY, P < .001) compared to the RF group. Additionally, the rate of early recurrence of atrial arrhythmia was lower in the CB-2 group (14.2 vs 23.3%, P = .047), but the long-term success rate was similar between two groups. CONCLUSIONS: CB-2 is associated with shorter procedure time, left atrial dwell time, and length of stay after ablation, but its costs and fluoroscopy time are greater than the RF group. Moreover, the rate of complications and long-term success are similar between the two groups.
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Chen et al. (2020) studied this question.
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