Long-term comparison of cryoballoon and radiofrequency ablation of paroxysmal atrial fibrillation: A propensity score matched analysis
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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Cited by (37)
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2023, Revista Portuguesa de CardiologiaMeta-Analysis Comparing Cryoballoon Versus Radiofrequency as First Ablation Procedure for Atrial Fibrillation
2020, American Journal of CardiologyCitation Excerpt :Overall, from the 14,419 titles and abstracts identified through database searching, 84 full-text studies were selected as potentially eligible and were thoroughly screened for eligibility (Supplementary Figure 1S). Thirty-four observational studies2–35 and 14 RCTs36–49 met our inclusion criteria and were taken into account for further consideration (Table 1). A total of 17,592 patients were included: 7,951 underwent CB ablation and the remaining 9,641 received RF ablation.
Burden-based classification of atrial fibrillation predicts multiple-procedure success of pulmonary vein isolation
2019, Journal of CardiologyCitation Excerpt :2D measurements [maximal lateral diameter (LAT 2D), anterior–posterior diameter (AP 2D), area (AREA 2D), and circumference (CIRC 2D)] were performed on axial slices. PVI only were performed using an irrigated-tip radiofrequency ablation catheter in combination with a 3D mapping system (Carto3, Biosense Webster, Diamond Bar, CA, USA) or cryoballoon (CB) catheters [13]. Briefly, for radiofrequency PVI, the geometrical reconstruction of the LA of the mapping system and the imported reconstruction from MRI or CT were used to guide the continuous circumferential antral ablation around the ipsilateral PVs.
Long Term Follow-up of Pulmonary Vein Isolation Using Cryoballoon Ablation
2016, Heart Lung and CirculationCitation Excerpt :Cryoballoon ablation is an established catheter-based approach used to isolate the pulmonary veins and has similar procedural success rates to radiofrequency catheter ablation [1–8]. To date, there is limited long-term data published evaluating the efficacy of cryoballoon ablation [9–11]. We have previously published medium-term results following cryoballoon ablation [12].
Pulmonary vein isolation using cryoballoon ablation versus RF ablation using ablation index following the CLOSE protocol: A prospective randomized trial
2022, Journal of Cardiovascular Electrophysiology
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SK and CS contributed equally to this manuscript.