What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Paroxysmal atrial fibrillation (n=637). Intervention: Visually guided laser balloon ablation vs. Cryoballoon ablation. Primary outcome: Atrial fibrillation recurrence (OR 0.66, 95% CI 0.42-1.05, p=0.078).

August 22, 2023Open Access

Efficacy and safety of visually guided laser balloon versus cryoballoon ablation for paroxysmal atrial fibrillation: a systematic review and meta-analysis

Key Result

Visually guided laser balloon ablation and cryoballoon ablation showed no significant difference in atrial fibrillation recurrence (16.3% vs. 22.7%, OR 0.66, p=0.078) for patients with paroxysmal atrial fibrillation.

Study Design

Type

Meta-Analysis (n=637)

Structured PICO

Does laser balloon ablation reduce AF recurrence and procedure-related complications compared to cryoballoon ablation in patients with paroxysmal atrial fibrillation?

Population

637 patients with paroxysmal atrial fibrillation undergoing initial catheter ablation, followed for a median of 12.4 months.

Intervention

Laser balloon ablation (LBA) (n=311)

Comparator

Cryoballoon ablation (CBA) (n=326)

Outcome

AF recurrence and procedure-related complications

Laser balloon ablation and cryoballoon ablation have comparable efficacy and safety for paroxysmal atrial fibrillation, though LBA is associated with longer procedural and left atrial dwell times.

Main Result

Odds Ratio: 0.66 (95% CI 0.42–1.05)

Absolute Event Rate: 16.3% vs 22.7%

p-value: p=0.078

Limitations

Small number of trials and relatively small total sample size.
Non-uniform atrial fibrillation recurrence definitions and monitoring strategies across trials, relying on Holter ECG rather than continuous rhythm monitoring.
First-generation laser balloons were used in all studies, which may not reflect the efficacy of newer generations.
Considerable heterogeneity was detected in the analysis of secondary outcomes.

Abstract

Background Newly developed catheter ablation (CA) techniques, such as laser balloon ablation (LBA) and cryoballoon ablation (CBA), have been introduced in recent years and emerged as valuable alternatives to conventional radiofrequency CA strategies for paroxysmal atrial fibrillation (PAF) patients. However, evidence comparing LBA and CBA remain controversial. Thus, we conducted this meta-analysis to assess the efficacy and safety between these two techniques. Methods Scientific databases (PubMed, Embase) and relevant websites (the Cochrane Library, ClinicalTrials. gov) were systematically searched from inception to March 2023. The primary outcomes of interest were the AF recurrence and the procedure-related complications. Secondary outcomes included procedural time, fluoroscopy time, and left atrial (LA) dwell time. Results Seven clinical trials with a total of 637 patients were finally enrolled. No significant differences were found between LBA and CBA in terms of AF recurrence 16. 3% vs. 22. 7%, odds ratio (OR) = 0. 66, 95% confidence interval (CI): 0. 42–1. 05, p = 0. 078 or total procedural-related complications (8. 4% vs. 6. 4%, OR = 1. 33, 95% CI: 0. 71–2. 51, p = 0. 371). LBA had a significantly longer procedural time weighted mean difference (WMD) = 38. 03 min, 95% CI: 13. 48–62. 58 min, p = 0. 002 and LA dwell time (WMD = 46. 67 min, 95% CI: 14. 63–78. 72 min, p = 0. 004) than CBA, but tended to have shorter fluoroscopy time. Conclusions LBA and CBA treatment have comparable efficacy and safety for PAF patients. LBA was associated with longer procedural and LA dwell times compared with CBA. Further large-scale studies are warranted to compare these two techniques with the newest generations. Systematic Review Registration: https: //www. crd. york. ac. uk/prospero/displayᵣecord. php? RecordID=426513, identifier (CRD42023426513).

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