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September 24, 2021Circulation JournalOpen Access

Comparison of Cryoballoon and Contact Force-Sensing Radiofrequency Ablation for Persistent Atrial Fibrillation in Clinical Practice

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Why the study?

Outcomes of cryoballoon ablation for persistent AF are unclear, especially in Japanese patients.

Does cryoballoon ablation reduce atrial arrhythmia recurrence compared to contact force-sensing radiofrequency ablation in Japanese patients with persistent atrial fibrillation?

Population

Consecutive patients with persistent AF (253 cryoballoon and 265 CFRF)

Comparison

Cryoballoon ablation vs CFRF ablation including the high-power protocol

Design

Retrospective comparative study

Follow-up

25.5±12.5 months

Key result

Cryoballoon ablation for persistent atrial fibrillation resulted in a comparable rate of freedom from atrial arrhythmia recurrence compared to contact force-sensing radiofrequency ablation (HR 0.85).

Discussion

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Overview

Comparable recurrence rates with cryoballoon versus CFRF in persistent AF; leaves open need for randomized confirmation before practice change.

Study Design

Type

Observational (n=518)

Multicenter

No

Structured PICO

Does cryoballoon ablation reduce atrial arrhythmia recurrence compared to contact force-sensing radiofrequency ablation in Japanese patients with persistent atrial fibrillation?

P
Population
518 patients with drug-resistant persistent atrial fibrillation, excluding those with long-lasting AF or enlarged left atrium, followed for a mean of 25.5 months.
E
Exposure
Cryoballoon ablation
C
Comparator
Contact force-sensing radiofrequency (CFRF) ablation including the high-power protocol
O
Outcome
Atrial arrhythmia recurrencehard clinical

Main Result

Hazard Ratio: 0.85 (95% CI 0.59–1.21)

Absolute Event Rate: 72.3% vs 69.8%

p-value: p=0.36

Cryoballoon ablation demonstrates comparable effectiveness and safety to contact force-sensing radiofrequency ablation for the treatment of persistent atrial fibrillation in routine clinical practice.

Limitations

  • Observational study design without randomized treatment assignment, with strategy left to operators' discretion.
  • The effect of the cryoballoon on excluded patients (e.g., those with thin LA or deformed PV) cannot be clarified.
  • Concomitant use of CFRF for touch-up and additional treatments in the cryoballoon group may have influenced the results.
  • Recurrence of asymptomatic arrhythmia may have been underestimated due to limited assessment with regular ECG and Holter monitoring rather than long-term continuous monitoring.

Cite This Study

A 2021 study conducted an observational in Persistent atrial fibrillation (n=518). Cryoballoon ablation vs. Contact force-sensing radiofrequency (CFRF) ablation was evaluated on Freedom from atrial arrhythmia recurrence (HR 0.85, 95% CI 0.59-1.21, p=0.36). Cryoballoon ablation for persistent atrial fibrillation resulted in a comparable rate of freedom from atrial arrhythmia recurrence compared to contact force-sensing radiofrequency ablation (HR 0.85).

synapsesocial.com/papers/6a990a9caa63da60ef78cc52https://doi.org/10.1253/circj.cj-21-0608
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Approaches to Catheter Ablation for Persistent Atrial Fibrillation2015 · 2,335 citations
  2. 2Cryoballoon or radiofrequency ablation for symptomatic paroxysmal atrial fibrillation: reintervention, rehospitalization, and quality-of-life outcomes in the FIRE AND ICE trial2016 · 353 citations
  3. 3The safety and efficacy of second-generation cryoballoon ablation plus catheter ablation for persistent atrial fibrillation: A systematic review and meta-analysis2018 · 15 citations
  4. 4Cryoballoon ablation of pulmonary veins for persistent atrial fibrillation: Results from the multicenter STOP Persistent AF trial2020 · 167 citations
  5. 5Cryoballoon Ablation for Pulmonary Vein Isolation in Patients With Persistent Atrial Fibrillation2015 · 87 citations