title: Is cryoballoon ablation preferable to radiofrequency ablation for treatment of atrial fibrillation by pulmonary vein isolation? A meta-analysis.
abstract: OBJECTIVE
  Currently radiofrequency and cryoballoon ablations are the two standard ablation systems used for catheter ablation of atrial fibrillation; however, there is no universal consensus on which ablation is the optimal choice. We therefore sought to undertake a meta-analysis with special emphases on comparing the efficacy and safety between cryoballoon and radiofrequency ablations by synthesizing published clinical trials.
  
  
  RESULTS
  Articles were identified by searching the MEDLINE and EMBASE databases before September 2013, by reviewing the bibliographies of eligible reports, and by consulting with experts in this field. Data were extracted independently and in duplicate. There were respectively 469 and 635 patients referred for cryoballoon and radiofrequency ablations from 14 qualified clinical trials. Overall analyses indicated that cryoballoon ablation significantly reduced fluoroscopic time and total procedure time by a weighted mean of 14.13 (95% confidence interval [95% CI]: 2.82 to 25.45; P = 0.014) minutes and 29.65 (95% CI: 8.54 to 50.77; P = 0.006) minutes compared with radiofrequency ablation, respectively, whereas ablation time in cryoballoon ablation was nonsignificantly elongated by a weighted mean of 11.66 (95% CI: -10.71 to 34.04; P = 0.307) minutes. Patients referred for cryoballoon ablation had a high yet nonsignificant success rate of catheter ablation compared with cryoballoon ablation (odds ratio; 95% CI; P: 1.34; 0.53 to 3.36; 0.538), and cryoballoon ablation was also found to be associated with the relatively low risk of having recurrent atrial fibrillation (0.75; 0.3 to 1.88; 0.538) and major complications (0.46; 0.11 to 1.83; 0.269). There was strong evidence of heterogeneity and low probability of publication bias.
  
  
  CONCLUSIONS
  Our findings demonstrate greater improvement in fluoroscopic time and total procedure duration for atrial fibrillation patients referred for cryoballoon ablation than those for radiofrequency ablation.
authors.affiliation: Department of Geratology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou, Fujian, China ; Department of Geratology, Fozhou General Hospital, Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Junxia
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Yingqun
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Hongbin
authors.initials: H
authors.lastname: Cai
authors.affiliation: Department of Epidemiology, Capital Medical University Affiliated Beijing An Zhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Qi
authors.affiliation: Department of Cardiology, The Fourth People's Hospital of Shenzhen, Shenzhen, Guangdong, China.
authors.forename: Nan
authors.initials: N
authors.lastname: Jia
authors.affiliation: Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Weifeng
authors.initials: W
authors.lastname: Shen
authors.affiliation: Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Jinxiu
authors.initials: J
authors.lastname: Lin
authors.affiliation: Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Peng
authors.affiliation: Department of Human Genetics and Biostatistics, Institute of Cardiovascular Disease, Dalian Medical University, Dalian, Liaoning, China ; Center for Evidence-Based Medicine, Institute of Cardiovascular Disease, Dalian Medical University, Dalian, Liaoning, China ; State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Wenquan
authors.initials: W
authors.lastname: Niu
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D002986:Clinical Trials as Topic; D003452:Cryosurgery / Q000379:methods*; D016206:Databases, Bibliographic; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011667:Pulmonary Veins / Q000601:surgery*; D016896:Treatment Outcome