Outcomes of cryoballoon or radiofrequency ablation in symptomatic paroxysmal or persistent atrial fibrillation

Aims: To evaluate the effectiveness and safety of cryoballoon ablation (CBA) compared with radiofrequency ablation (RFA) for symptomatic paroxysmal or drug-refractory persistent atrial fibrillation (AF). Methods and results: Prospective cluster cohort study in experienced CBA and RFA centres. Primary endpoint was 'atrial arrhythmia recurrence', secondary endpoints were as follows: procedural results, safety, and clinical course. A total of 4189 patients were included: CBA 2329 (55.6%) and RFA 1860 (44.4%). Cryoballoon ablation population was younger, with fewer comorbidities. Procedure time was longer in the RFA group (P = 0.01). Radiation exposure was 2487 (CBA) and 1792 cGycm2 (RFA) (P < 0.001). Follow-up duration was 441 (CBA) and 511 days (RFA) (P < 0.0001). Primary endpoint occurred in 30.7% (CBA) and 39.4% patients (RFA) [adjusted hazard ratio (adjHR) 0.85, 95% confidence interval (CI) 0.70-1.04; P = 0.12). In paroxysmal AF, CBA resulted in a lower risk of recurrence (adjHR 0.80, 95% CI 0.64-0.99; P = 0.047). In persistent AF, the primary outcome was not different between groups. Major adverse cardiovascular and cerebrovascular event rates were 1.0% (CBA) and 2.8% (RFA) (adjHR 0.53, 95% CI 0.26-1.10; P = 0.088). Re-ablations (adjHR 0.46, 95% CI 0.34-0.61; P < 0.0001) and adverse events during follow-up (adjHR 0.64, 95% CI 0.48-0.88; P = 0.005) were less common after CBA. Higher rehospitalization rates with RFA were caused by re-ablations. Conclusions: The primary endpoint did not differ between CBA and RFA. Cryoballoon ablation was completed rapidly; the radiation exposure was greater. Rehospitalization due to re-ablations and adverse events during follow-up were observed significantly less frequently after CBA than after RFA. Subgroup analysis suggested a lower risk of recurrence after CBA in paroxysmal AF. Trial Registration: ClinicalTrials.gov (NCT01360008), https://clinicaltrials.gov/ct2/show/NCT01360008.

Authors
Hoffmann E.1 , Straube F.1 , Dorwarth U.1 , Wegscheider K.2 , Kuniss M.3 , Andresen D.4 , Wu L.Q.5 , Tebbenjohanns J.6 , Noelker G.7 , Tilz R.R. 8, 9 , Metzner A. 9 , Kuck K.H. 9 , Chun J.K.R.10 , Franke A.11 , Stellbrink C. 12 , Garcia-Alberola A.13 , Ouarrak T.14 , Senges J.14 , Brachmann J.15 , Souza J.J. , Stanley A. , Spitzer S.G. , Willems S. , Dierk T. , Borchard R. , Seidl K.H. , Zahn R. , Groschup G. , Obel I.W.P. , Gerds-Li J.H. , Gopal R.R. , Schrickel J. , Lewalter T. , Moshage W. , Eckardt L. , Jung W. , Kremer P. , Lubinski A. , Schumacher B. , Lickfett L. , Muenzel T. , Steinwender C. , Efremidis M. , Deneke T. , Nguyen D.Q. , Hochadel M. , Schneider S.
Journal
Europace
Number of issue
9
Language
English
Pages
1313-1324
Status
Published
Volume
21
Year
2019
Organizations
  • 1 Department of Cardiology and Internal Intensive Care Medicine|Heart Center Munich-Bogenhausen|Munich Municipal Hospital Group
  • 2 Department of Medical Biometry and Epidemiology|University Medical Center Eppendorf
  • 3 Department of Cardiology|Kerckhoff Clinic
  • 4 Department of Cardiology at Evangelisches Krankenhaus Hubertus|Paul Gerhardt Diakonie GAG
  • 5 Department of Cardiology|Rui Jin Hospital|Shanghai Jiaotong University School of Medicine
  • 6 HELIOS Klinikum Hildesheim|Medizinische Klinik i - Kardiologie
  • 7 Department of Cardiology|Herz-und Diabeteszentrum Nordrhein-Westfalen
  • 8 Department of Cardiology|Angiology and Intensive Care Medicine|University Heart Centre Luebeck|University Hospital Schleswig-Holstein
  • 9 Department of Cardiology|Asklepios Clinic St. Georg
  • 10 Cardioangiologisches Centrum Bethanien|Markus Krankenhaus
  • 11 Department of Cardiology|KRH Klinikum Siloah-Oststadt-Heidehaus
  • 12 Department of Cardiology
  • 13 Department of Cardiology|University Hospital Virgen de la Arrixaca
  • 14 Stiftung Institut fuer Herzinfarktforschung
  • 15 Department of Cardiology|REGIOMED Kliniken
Keywords
atrial fibrillation; catheter ablation; cryoballoon; paroxysmal; persistent; radiofrequency
Date of creation
20.02.2020
Date of change
20.02.2020
Short link
https://repository.rudn.ru/en/records/article/record/59533/
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