Quality of life after cryoballoon vs. radiofrequency ablation in atrial fibrillation: a subanalysis of the FREEZE cohort study

Background Catheter ablation for symptomatic atrial fibrillation (AF) is an established treatment, with cryoballoon (CBA) and radiofrequency ablation (RFA) showing similar success rates. However, comparative data on health-related quality of life (HRQoL) outcomes between these methods are limited. This study compares HRQoL changes following CBA vs. RFA in symptomatic AF patients. Methods This sub-analysis of the FREEZE Cohort Study (NCT01360008) compared HRQoL outcomes between CBA (group A) and RFA (group B) using the EQ-5D-3L questionnaire and EHRA symptom scores at baseline and follow-up. Changes in mobility, self-care, usual activities, pain/discomfort, anxiety/depression, EQ-VAS, and general physical condition (GPC) were assessed. Results Between 2011 and 2016, 4,189 patients were included, with 2,110 (50.4%) completing all HRQoL questionnaires. The mean age was 61.8 ± 10.4 years, with 39.2% female patients. Group A had a higher proportion of patients with paroxysmal AF (72.8% vs. 65.4%, p < 0.01). Overall complication rates were similar (7.6% vs. 10.1%, p = 0.07). The median follow-up was 434 (375, 517) days. Atrial arrhythmia recurrence was more frequent in group B (45.0% vs. 56.9%, p < 0.0001), as were repeat ablations (7.9% vs. 22.3%, p < 0.001) and rehospitalizations (26.0% vs. 46.7%, p < 0.0001). Both groups experienced significant improvements in HRQoL. After multivariable adjustment, group A remained associated with greater improvement in pain/discomfort (aOR 1.62, 95% CI 1.26–2.08), EQ-VAS (aOR 1.60, 95% CI 1.27–2.02), and the EuroQol 5D-Score (aOR 1.39, 95% CI 1.10–1.76). Conclusion Both CBA and RFA significantly improved HRQoL. However, CBA was associated with greater improvements in pain/discomfort, EQ-VAS, and the EuroQol 5D-Score, indicating potential differences in selected HRQoL outcomes between ablation modalities. Clinical Trial Registration: NCT01360008.