Long‐term outcomes of index cryoballoon ablation or point‐by‐point radiofrequency ablation in patients with atrial fibrillation and systolic heart failure

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation and systolic heart failure (n=206). Intervention: Cryoballoon ablation vs. Radiofrequency ablation. Primary outcome: Single procedure freedom from AF/AT (>30s) (p=0.48).

Sandeep S. Prabhu; Nikhil Ahluwalia; Sara Tyebally; Adam S. Dennis; Samuel Malomo; Aderonke Abiodun; Angelos Tyrlis; Gurpreet Singh Dhillon; Louise A. Segan; Adam J. Graham; Shohreh Honarbakhsh; Vinit Sawhney; Simon Sporton; MARTIN D. LOWE; Malcolm Finlay; Mark J. Earley; Pier David Lambiase; RICHARD JOHN SCHILLING; Ross Jacob Hunter

doi:10.1111/jce.14923

Key result

Cryoballoon ablation shows similar arrhythmia-free survival to radiofrequency ablation in AF and systolic heart failure.

P=0.48
n=206

Why the study?

The role of cryoablation for atrial fibrillation treatment in patients with systolic heart failure was unclear.

Does index cryoballoon ablation improve freedom from AF recurrence and LVEF compared to radiofrequency ablation in patients with atrial fibrillation and systolic heart failure?

Key Points

To assess procedural success, arrhythmia recurrence, and left ventricular ejection fraction improvement following index cryoballoon ablation compared to radiofrequency ablation in patients with atrial fibrillation and systolic heart failure.
Evaluated patients with left ventricular systolic dysfunction (LVEF ≤ 45%) undergoing index catheter ablation using cryoablation.
Compared outcomes at long-term follow-up to a contemporaneous cohort of heart failure patients undergoing index point-by-point radiofrequency ablation.
Freedom from atrial fibrillation recurrence after index cryoballoon ablation occurred in 43% of patients, increasing to 59% following a repeat ablation procedure.
Patients achieved significant improvements in left ventricular ejection fraction and functional status at long-term follow-up, demonstrating outcomes comparable to radiofrequency ablation.

Study Design

Type

Cohort (n=206)

Multicenter

No

Structured PICO

Does index cryoballoon ablation improve freedom from AF recurrence and LVEF compared to radiofrequency ablation in patients with atrial fibrillation and systolic heart failure?

P

Population

206 patients with atrial fibrillation and systolic heart failure (LVEF ≤45%) undergoing index catheter ablation were followed for an average of 30 months.

E

Exposure

Index catheter ablation with cryoballoon ablation

C

Comparator

Contemporaneous cohort undergoing index ablation with point-by-point radiofrequency ablation

O

Outcome

Procedural success, freedom from AF recurrence, and left ventricular systolic dysfunction (LVEF) improvement at long-term follow-up

Main Result

Absolute Event Rate: 43% vs 38%

p-value: p=0.48

Limitations

Retrospective analysis subject to selection bias
Effect of interventions such as revascularisation or up-titration of anti-failure medical therapy could not be controlled for
Non-randomised study design

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Implication

Cryoballoon ablation is an effective first-line approach for atrial fibrillation in patients with systolic heart failure, yielding comparable long-term outcomes to radiofrequency ablation.

Abstract

Catheter ablation is an established effective approach for the treatment of atrial fibrillation (AF) in patients with heart failure, however, the role of cryoablation in this setting is unclear. Procedural success and left ventricular systolic dysfunction (LVEF) improvement in patients with LVEF ≤ 45% undergoing index catheter ablation with cryoablation were evaluated. Freedom from AF recurrence was seen in 43% rising to 59% following repeat procedure. There were significant improvements in LVEF and functional status at long-term follow-up. Results were comparable to a contemporaneous cohort of heart failure patients undergoing index ablation with radiofrequency ablation. Cryoablation is an effective first-line AF ablation approach in the setting of heart failure.

Discussion

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Cite This Study

Prabhu et al. (2021) conducted a cohort in Atrial fibrillation and systolic heart failure (n=206). Cryoballoon ablation vs. Radiofrequency ablation was evaluated on Single procedure freedom from AF/AT (>30s) (p=0.48). In patients with atrial fibrillation and systolic heart failure, an initial strategy of cryoballoon ablation resulted in similar single-procedure freedom from arrhythmia compared to radiofrequency ablation.

synapsesocial.com/papers/6ab5bc9df0c285845c86276e https://doi.org/10.1111/jce.14923

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Long‐term outcomes of index cryoballoon ablation or point‐by‐point radiofrequency ablation in patients with atrial fibrillation and systolic heart failure

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Long‐term outcomes of index cryoballoon ablation or point‐by‐point radiofrequency ablation in patients with atrial fibrillation and systolic heart failure

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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