Jitae A Kim1, Mihail G Chelu2,3,4. 1. Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA. 2. Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA. Mihail.Chelu@bcm.edu. 3. Baylor St. Luke's Medical Center, Houston, TX, USA. Mihail.Chelu@bcm.edu. 4. Texas Heart Institute, Houston, TX, USA. Mihail.Chelu@bcm.edu.
Abstract
BACKGROUND: There is limited data comparing radiofrequency (RF) and cryoballoon (CB) ablation for persistent atrial fibrillation (AF), which tends to have higher recurrence rates following ablation compared to paroxysmal AF. METHODS: A systematic search of the Embase, PubMed, and Cochrane database was performed for studies comparing RF vs CB ablation for persistent AF. An inverse-variance random-effects model was used to calculate the composite effects. RESULTS: One randomized and 9 observational studies were identified, with 1650 patients receiving CB and 1706 patients receiving RF ablation. Mean follow-up time ranged from 12 to 48 months. Freedom from recurrent atrial tachyarrhythmia was similar with the two modalities (HR 0.93, 95% CI 0.80 to 1.08, I2 0%). Total complications were similar in both groups (RR 1.05, 95% CI 0.73 to 1.53, I2 0%) although rates of phrenic nerve palsy (PNP) were greater with CB (RR 4.13, 95% CI 1.49 to 11.46, I2 0%). Shorter procedure times were observed with CB (mean reduction 43.77 min, 95% CI 66.45 to 21.09 min, I2 96%) with no difference in fluoroscopy time (mean difference 0.82 min, 95% CI - 11.92 to 13.55 min, I2 100%). CONCLUSIONS: In persistent AF patients, CB ablation has similar efficacy and overall safety as compared to RF ablation. While CB is associated with significantly shorter procedure times, the improved procedural efficiency with CB is offset by increased rates of PNP and the potential need for touch-up RF ablation.
BACKGROUND: There is limited data comparing radiofrequency (RF) and cryoballoon (CB) ablation for persistent atrial fibrillation (AF), which tends to have higher recurrence rates following ablation compared to paroxysmal AF. METHODS: A systematic search of the Embase, PubMed, and Cochrane database was performed for studies comparing RF vs CB ablation for persistent AF. An inverse-variance random-effects model was used to calculate the composite effects. RESULTS: One randomized and 9 observational studies were identified, with 1650 patients receiving CB and 1706 patients receiving RF ablation. Mean follow-up time ranged from 12 to 48 months. Freedom from recurrent atrial tachyarrhythmia was similar with the two modalities (HR 0.93, 95% CI 0.80 to 1.08, I2 0%). Total complications were similar in both groups (RR 1.05, 95% CI 0.73 to 1.53, I2 0%) although rates of phrenic nerve palsy (PNP) were greater with CB (RR 4.13, 95% CI 1.49 to 11.46, I2 0%). Shorter procedure times were observed with CB (mean reduction 43.77 min, 95% CI 66.45 to 21.09 min, I2 96%) with no difference in fluoroscopy time (mean difference 0.82 min, 95% CI - 11.92 to 13.55 min, I2 100%). CONCLUSIONS: In persistent AF patients, CB ablation has similar efficacy and overall safety as compared to RF ablation. While CB is associated with significantly shorter procedure times, the improved procedural efficiency with CB is offset by increased rates of PNP and the potential need for touch-up RF ablation.
Authors: Ersan Akkaya; Alexander Berkowitsch; Sergej Zaltsberg; Harald Greiss; Christian W Hamm; Johannes Sperzel; Thomas Neumann; Malte Kuniss Journal: J Cardiovasc Electrophysiol Date: 2018-01-15
Authors: Karl-Heinz Kuck; Josep Brugada; Alexander Fürnkranz; Andreas Metzner; Feifan Ouyang; K R Julian Chun; Arif Elvan; Thomas Arentz; Kurt Bestehorn; Stuart J Pocock; Jean-Paul Albenque; Claudio Tondo Journal: N Engl J Med Date: 2016-04-04 Impact factor: 91.245
Authors: Ellen Hoffmann; Florian Straube; Karl Wegscheider; Malte Kuniss; Dietrich Andresen; Li-Qun Wu; Jürgen Tebbenjohanns; Georg Noelker; Roland Richard Tilz; Julian Kyoung Ryul Chun; Andreas Franke; Christoph Stellbrink; Arcadi Garcia-Alberola; Uwe Dorwarth; Andreas Metzner; Taoufik Ouarrak; Johannes Brachmann; Karl-Heinz Kuck; Jochen Senges Journal: Europace Date: 2019-09-01 Impact factor: 5.214