Cryoballoon versus radiofrequency catheter ablation for paroxysmal atrial fibrillation

Background: Catheter ablation is an established treatment for atrial fibrillation (AF). Cryoballoon ablation (CBA) has emerged as an alternative to radiofrequency ablation (RFA). However, there are few data comparing these modalities for treatment of paroxysmal AF (pAF) in the U.S.

Population: The purpose of this study was to compare procedural times, safety, and efficacy of CBA against RFA.

Methods: A single-center prospective cohort study evaluated patients who underwent catheter ablation for pAF using CBA or RFA between January 1, 2010 and October 31, 2013. Patients with prior ablation and those without rhythm follow-up for at least 3 months were excluded. The primary end point was freedom from AF, atrial flutter, and atrial tachycardia (FFAF) >30 seconds after a 3-month blanking period without requirement for antiarrhythmic drugs. We also compared rates of successful pulmonary vein isolation (PVI), fluoroscopy and procedure times, and major complication rates.

Results: A total of 201 patients were included (CBA = 101, RFA = 100). The rate of successful PVI was 99.3% in CBA versus 97.4% in RFA (P = 0.08). Procedure times were shorter with CBA (192.9 ± 44.0 minutes vs 283.7 ± 78.0 minutes, P < 0.001) as well as total fluoroscopy times (46.0 ± 22.4 minutes vs 73.0 ± 30.1 minutes, P < 0.001). Overall complication rates were equivalent; however, fewer cardiac perforations occurred with CBA (0% vs 4%, P = 0.042). The 1-year FFAF rates were 60.3% for CBA and 61.1% for RFA (log rank P = 0.93).

Conclusion: CBA was associated with equivalent 1-year FFAF rate as RFA for pAF. Procedure and fluoroscopy times were shorter for CBA and fewer cardiac perforations occurred.