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Background Pulmonary vein isolation (PVI) is a standard ablation strategy that can be achieved with cryoablation (Cryo) with a single-shot cryoballoon catheter or point-by-point radiofrequency (RF) ablation to treat symptomatic paroxysmal atrial fibrillation (PAF). This study aims to compare the clinical outcome of catheter ablation between Cryo and RF using standard approaches. Methods This is a single-centre, retrospective study of 198 consecutive patients who underwent de novo PVI for PAF from 2018 to 2019. Acute procedural success was defined as PVI, confirmed with a bidirectional block at the end of all AF ablation. Freedom from documented AF at 12 months after ablation was compared between the cryo and RF groups from available patient records. Atrial arrhythmias that occurred during the blanking period in the first three months after ablation were not included in the analysis of AF recurrence. Patients who received substrate ablation in addition to the pulmonary veins (PVs) were excluded from the study. All Patients were matched by demographics and indexed left atrial volume. Results After excluding patients who had received additional ablations to PVs, 44 matched pairs were included in the analysis, of which 62 (71%) were males. The mean age was 59 ± 13 years old. The most common comorbidity was hypertension in 38 patients (43%). Freedom from documented AF after the blanking period was similar between RF and cryo at– 35 patients in the RF group (80%) vs 25 patients in the cryo group (57%), p=0.06 after a median follow-up of 12 months (IQR 10–14 months). The Antiarrhythmic drugs (AAD) used include flecainide and sotalol in 23 (52%) RF patients and 18 (59%) cryo patients. There was no significant difference in the use of before or after ablation or the length of AAD use after ablation between the cryo and RF groups. No major procedural complications had occurred in either group, and no sustained phrenic nerve palsy had happened in the cryo group. Details of baseline clinical characteristics and outcomes are demonstrated in table 1. Conclusion In patients undergoing de novo PVI for PAF without additional substrate ablations, cryo resulted in similar rates of freedom from AF compared to RF at 12 months. Conflict of Interest Nil
Antoun et al. (Mon,) studied this question.