Abstract 14207: Cryoballoon or Irrigated Radiofrequency Ablation for Atrial Fibrillation: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Background: Pulmonary-vein isolation by means of catheter ablation is the treatment of choice for drug-refractory atrial fibrillation (AF). Previous studies suggested that cryoballoon ablation has clinical benefits comparable to those of radiofrequency ablation, but the optimal method remains unclear. We aimed to assess the efficacy and safety of cryoballoon ablation compared with irrigated radiofrequency ablation for the treatment of AF, based on last clinical data.
Methods: PubMed, Embase and Cochrane databases were searched until April 2016. We included only studies that randomized patients with AF to cryoballoon ablation versus irrigated radiofrequency ablation. The primary clinical outcome was the proportion of patients free from AF at long-term follow-up. The secondary outcomes were procedure time, fluoroscopy time and complications.
Results: Seven randomized studies were included, comprising 1476 patients (736 received cryoballoon ablation and the remaining 740 received radiofrequency ablation). Cryoballoon ablation was associated with similar proportion of patients free from AF at a mean 13 months follow-up when compared to irrigated radiofrequency ablation (64% versus 63%; relative risk [RR] 0.99, CI 95% 0.85 to 1.15, P=0.87). There were no differences in the procedure time for both methods (mean 146 vs 150 min; weighted mean difference [WMD] -3.24, 95% CI -21.49 to 15.01, P=0.73) and the fluoroscopy time was higher in the cryoballoon group (34 vs 29 min; WMD 5.05, 3.17 to 6.92, P <0.001). Total complications were similar between the two groups (9.6 vs 8.6%, RR 1.47, 0.70 to 3.09, P=0.30), but phrenic-nerve injury was more frequent in the cryoballoon group (4.3 % vs 0%, P <0.001). No atrioesophageal fistula was reported.
Conclusions: The present meta-analysis that includes only randomized data showed similar efficacy and procedure duration for both methods in AF treatment with higher rate of phrenic-nerve injury and fluoroscopy time for cryoballoon ablation.
Author Disclosures: J. Carmo: None. F.M. Costa: None. D. Cavaco: None. J. Ferreira: None. N. Lopes: None. P. Carmo: None. F. Morgado: None. P. Adragão: None.
- © 2016 by American Heart Association, Inc.