Key result
Cryoballoon ablation reduces acute left pulmonary vein narrowing by ~66% vs RF ablation.
Why the study?
It was unclear whether cryoballoon or radiofrequency ablation causes different extents of acute or chronic pulmonary vein narrowing after isolation in paroxysmal atrial fibrillation.
Does cryoballoon ablation reduce acute and chronic pulmonary vein stenosis compared to radiofrequency ablation in patients with paroxysmal atrial fibrillation?
RCT (n=50)
1:1
Does cryoballoon ablation reduce acute and chronic pulmonary vein stenosis compared to radiofrequency ablation in patients with paroxysmal atrial fibrillation?
Cryoballoon ablation results in less acute pulmonary vein narrowing compared to radiofrequency ablation, though both modalities show similar, low rates of chronic stenosis at 3 months.
Answers are grounded in this paper and cite their sources.
Favors cryoballoon over RF to limit acute left PV narrowing in paroxysmal AF; extends RCT data on modality-specific PV effects.
BACKGROUND: Cryoballoon (CB) applications to pulmonary veins (PVs) can cause stenosis just as radiofrequency (RF) energy deliveries. The goal of the present study was to clarify whether or not there was any difference in the extent of acute or chronic PV narrowing after PV isolation between the two different energy sources. METHODS: Consecutive patients with paroxysmal atrial fibrillation who were scheduled to undergo a PV isolation were randomized 1:1 to receive CB or RF ablation. The endpoints were any acute PV narrowing assessed with the use of intracardiac ultrasound during the procedure and PV stenosis measured with cardiac computed tomography at the 3-month follow-up. RESULTS: An acute reduction in the luminal area of the left superior PV (mean ± standard deviation, -6.8 ± 8.7 vs -19.9 ± 14.7%; P < 0.001) and left inferior PV (-5.1 ± 20.2 vs -15.3 ± 11.6%; P = 0.03) was significantly smaller in the CB arm (N = 25) than the RF arm (N = 25). There was no difference in the extent of PV stenosis 3 months after the ablation between the arms (0-25% stenosis, 90% vs 88%, 25-50% stenosis, 10% vs 12%, >50% stenosis, both 0%; P = 0.82). A greater acute PV narrowing was likely to lead to chronic stenosis in the RF arm (P = 0.004). CONCLUSIONS: CB ablation may reduce the acute narrowing of the left-sided PVs as compared to RF ablation.
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Watanabe et al. (2018) conducted an RCT in paroxysmal atrial fibrillation (n=50). Cryoballoon ablation vs. Radiofrequency ablation was evaluated on Acute reduction in the luminal area of the left superior pulmonary vein (p=<0.001). Cryoballoon ablation resulted in significantly smaller acute narrowing of the left superior (-6.8% vs -19.9%; P<0.001) and left inferior pulmonary veins compared to RF ablation.
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