Long-term comparison of cryoballoon and radiofrequency ablation of paroxysmal atrial fibrillation: A propensity score matched analysis

https://doi.org/10.1016/j.ijcard.2014.06.038Get rights and content

Highlights

  • Randomized studies comparing cryoballoon and radiofrequency ablation are lacking.

  • We used propensity-score matching to perform an unbiased comparison.

  • During a follow-up of 28 months, the AF recurrence rate was similar in both groups.

  • Procedure duration was similar and rate of complications was equal in both groups.

Abstract

Background

Although radiofrequency (RF) and cryoballoon (CB) based technologies for pulmonary vein isolation (PVI) have both individually been demonstrated to be effective and safe for the treatment of paroxysmal AF, head-to-head comparisons are lacking. The purpose of this study was to compare the outcome of cryoballoon versus radiofrequency ablation in patients with paroxysmal atrial fibrillation undergoing pulmonary vein isolation.

Methods

Out of a prospective registry of 327 patients undergoing PVI, 208 patients (age 58 ± 11 years, ejection fraction 59 ± 6%, left atrial size 39 ± 6 mm) with paroxysmal AF were identified. The presented dataset was obtained by 1:1 propensity score matching and contained 142 patients undergoing CB-PVI or RF-PVI in conjunction with a 3D mapping system, respectively. We compared single procedure efficacy of the two methods using a Cox proportional hazards model.

Results

After a mean follow-up of 28 months and a single procedure, AF recurred in 37 of 71 (52%) in the CB-PVI group and in 31 of 71 patients (44%) in the RF-PVI group (HR [95% CI] = 1.19 [0.74, 1.92], p = 0.48). Recurrence of AF for PVI using solely the CB was observed in 23 of 51 (45%) patients and in 23 of 51 (45%) patients in the corresponding RF-PVI group (HR [95% CI] = 0.93 [0.52, 1.66], p = 0.81). Complication rate was not different between the groups.

Conclusion

A propensity score matched comparison between CB-PVI and RF-PVI using a 3D-mapping system for AF ablation showed similar long-term success rates.

Introduction

Pulmonary vein isolation (PVI) has become the cornerstone of interventional treatment of paroxysmal atrial fibrillation (AF) [1]. Currently, the procedural endpoint of PVI is most frequently achieved by performing point-by-point ablation by means of radiofrequency (RF) energy in combination with an electroanatomical mapping system [2]. A balloon-based technology using cryoenergy for PVI is increasingly used and has been developed in order to simplify the creation of a complete circumferential lesion around the pulmonary veins (PV) with only a limited number of applications [3]. Recently, the safety and efficacy of cryoballoon pulmonary vein isolation (CB-PVI) compared to antiarrhythmic drugs have been shown for the treatment of patients with paroxysmal AF [4] and a plethora of non-randomized single-center studies reporting success rates of CB-PVI have been published [5], [6], [7], [8], [9], [10], [11]. In the absence of a randomized trial, we used propensity-score matching to perform an unbiased comparison with long-term follow-up after CB-PVI and RF-PVI in conjunction with an electroanatomical mapping system in patients with paroxysmal AF.

Section snippets

Study population

We included 327 consecutive patients with documented episodes of AF into the prospective “Basel Atrial Fibrillation Pulmonary Vein Isolation” (BEAT-AF-PVI) cohort study. For the present study patients with paroxysmal AF undergoing PVI, either using RF or balloon-based cryoablation were analyzed. Persistent or permanent AF, a history of any previous left atrial procedure (surgical or percutaneous) or the use of a magnetic navigation system were exclusion criteria for the purpose of this

Study population

The resulting propensity score matched data set included 142 patients, 71 with CB-PVI and 71 with RF-PVI. The flowchart of the study with the analyzed groups can be found in Fig. 1. A summary of the baseline characteristics is shown in Table 1. The patients had a mean age of 58 ± 11 years, 74% were men and the left atrial size in the parasternal long axis was 39 ± 6 mm. Atypical PV anatomy was identified in 23 patients (16.3%), with 13 patients (9.2%) having an additional right middle PV, 1 patient

Discussion

The main findings of our study are: 1) During a follow-up of 28 months, the AF recurrence rate in patients undergoing CB-PVI was similar when compared to propensity score matched patients undergoing RF-PVI. 2) Procedure duration was similar in both groups, but fluoroscopy time was significantly shorter with RF-PVI. 3) The rate of complications was equal in the two groups.

Since the introduction of the CB into clinical practice, several single center studies have been published reporting

Conclusion

A propensity score matched comparison between CB-PVI and RF-PVI using a 3D-mapping system for AF ablation showed similar long-term success rates.

Grant support

The BEAT-AF PVI study was supported by grants from the Basel University, the “Freiwillige Akademische Gesellschaft” (FAG) Basel, the University Hospital Basel, Bayer, Daiichi-Sankyo and Sanofi-Aventis. David Conen was supported by a grant of the Swiss National Science Foundation (PP00P3_133681).

Conflict of interest

Christian Sticherling is member of Medtronic Advisory Board Europe and received educational grants from Biosense Webster. Peter Ammann is member of the Medtronic Advisory Board Europe. He received unrestricted grants from Biosense Webster, Boston Scientific, and Medtronic. Stefan Osswald served on the speakers' bureau for Medtronic, Boston Scientific, Biotronik, St Jude Medical, Sanofi-Aventis, and Astra Zeneca and received unrestricted grants from Medtronic, Boston Scientific, Biotronik, and

Author contribution

Sven Knecht — This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

Christian Sticherling — This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

Stefanie von Felten — Conception and design, analysis and interpretation of data.

David Conen — Critical revision of manuscript for important intellectual content.

Peter

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