Abstract 16802: Efficacy and Safety of Cryoballoon versus Radiofrequency Ablation for Atrial Fibrillation: A Meta-analysis of Randomized Clinical Trials
Background: The comparative efficacy and safety of cryoballoon (CB) ablation vis-à-vis radiofrequency (RF) ablation for pulmonary vein (PV) isolation in atrial fibrillation (AF) is unclear.
Objectives: To systematically compare the efficacy and safety of CB versus RF ablation in randomized clinical trials (RCTs).
Methods: Electronic search of MEDLINE and Cochrane Library databases was conducted for RCTs that randomized patients with paroxysmal or persistent AF to CB versus RF ablation. Random effects DerSimonian-Laird risk ratios (RR) were calculated. The main outcome was freedom from AF after single ablation procedure without use of anti-arrhythmic drugs (AADs).
Results: Seven randomized trials with total of 1,520 patients were included. Mean age was 59±10 years, and 72% of population were males. Mean duration of AF was 5 years. PV isolation was successful acutely in 90% of PVs targeted by CB compared with 99% of PVs targeted by RF. Acute procedural success was achieved in 84% CB patients and 99% RF patients (p=0.14). Freedom from documented AF after single procedure was similar in CB compared with RF ablation (61.0% vs 59.3%; RR=1.00; 95% CI 0.68-1.48; p=1.00), over mean follow-up duration of 12 months (Figure 1). Repeated ablation was required in 11.7% of CB group versus 10.1% of RF group (RR=1.16; 95% CI 0.80-1.67; p=0.44). Mean procedural and fluoroscopy times were similar in both arms (SMD=10.10; 95% CI -10.29-30.48; p=0.33, and SMD=-0.16; 95% CI -7.99-7.66; p=0.97; respectively). CB ablation was associated with increased risk of transient phrenic nerve palsy (RR=10.20; 95% CI 3.05-34.10; p=0.0002) (Figure 2), while vascular complications were similar in both groups (RR=0.57; 95% CI 0.26-1.23; p=0.15).
Conclusions: CB ablation possess similar efficacy to RF ablation in management of paroxysmal or persistent AF; however, with increased risk of transient phrenic nerve palsy.
Author Disclosures: M. Saad: None. R. Nairooz: None. I.Y. Elgendy: None. A. Mentias: None. A.Y. Elgendy: None. A.F. Barakat: None. A. Abuzaid: None. A.N. Mahmoud: None. A. Sewani: None. W. Maskoun: None. S. Saksena: None.
- © 2016 by American Heart Association, Inc.