Acute and Long-Term Outcomes of Catheter Ablation of Atrial Fibrillation Using the Second-Generation Cryoballoon versus Open-Irrigated Radiofrequency: A Multicenter Experience.
BACKGROUND
There are limited comparative data on catheter ablation of atrial fibrillation (CAAF) using the second-generation cryoballoon (CB-2) versus point-by-point radiofrequency (RF). This study examines the acute/long-term CAAF outcomes using these 2 strategies.


RESULTS
In this multicenter, retrospective, nonrandomized analysis, procedural and clinical outcomes of 1,196 patients (76% with paroxysmal AF) undergoing CAAF using CB-2 (n = 773) and open-irrigated, non-force sensing RF (n = 423) were evaluated. Pulmonary vein isolation was achieved in 98% with CB-2 and 99% with RF (P = 0.168). CB-2 was associated with shorter ablation time (40 ± 14 min vs. 66 ± 26 min; P < 0.001) and procedure time (145 ± 49 minutes vs. 188 ± 42 minutes; P < 0.001), but greater fluoroscopic utilization (29 ± 13 minutes vs. 23 ± 14 minutes; P < 0.001). While transient (7.6% vs. 0%; P < 0.001) and persistent (1.2% vs. 0%; P = 0.026) phrenic nerve palsy occurred exclusively with CB-2, other adverse event rates were similar between CB-2 (1.6%) and RF (2.6%); P = 0.207. However, freedom from AF/atrial flutter/tachycardia at 12 months following a single procedure without antiarrhythmic therapy was greater with CB-2 (76.6%) versus RF (60.4%); P < 0.001. While this difference was evident in patients with paroxysmal AF (P < 0.001), it did not reach significance in those with persistent AF (P = 0.089). Additionally, CB-2 was associated with reduced long-term need for antiarrhythmic therapy (16.7% vs. 22.0%; P = 0.024) and repeat ablations (14.6% vs. 24.1%; P < 0.001).


CONCLUSIONS
In this multicenter, retrospective, nonrandomized study, CAAF using CB-2 coupled with RF as occasionally required was associated with greater freedom from atrial arrhythmias at 12 months following a single procedure without antiarrhythmic therapy when compared to open-irrigated, non-force sensing RF, alone.
Regional Cardiology Associates and Dignity Health Heart & Vascular Institute, Sacramento, California, USA.
Arash
A
Aryana
Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
Sheldon M
SM
Singh
Division of Cardiac Electrophysiology, Staten Island University Hospital, Staten Island, New York, USA.
Marcin
M
Kowalski
Department of Cardiothoracic Surgery, CHI Baylor St. Luke's Medical Center, Texas Heart Institute, Houston, Texas, USA.
Deep K
DK
Pujara
Aurora Denver Cardiology Associates, Aurora, Colorado, USA.
Andrew I
AI
Cohen
Department of Cardiothoracic Surgery, CHI Baylor St. Luke's Medical Center, Texas Heart Institute, Houston, Texas, USA.
Steve K
SK
Singh
Division of Cardiac Electrophysiology, University of Colorado, Denver, Colorado, USA.
Ryan G
RG
Aleong
Hoag Hospital, Newport Beach, CA and University of California Irvine Medical Center, Orange, California, USA.
Rajesh S
RS
Banker
Aurora Denver Cardiology Associates, Aurora, Colorado, USA.
Charles E
CE
Fuenzalida
Aurora Denver Cardiology Associates, Aurora, Colorado, USA.
Nelson A
NA
Prager
Regional Cardiology Associates and Dignity Health Heart & Vascular Institute, Sacramento, California, USA.
Mark R
MR
Bowers
Instituto de Pesquisa em Arritmia Cardiaca (IPAC), Hospital Cardiologico-Florianopolis, Florianopolis, South Carolina, Brazil.
André
A
D'Avila
Regional Cardiology Associates and Dignity Health Heart & Vascular Institute, Sacramento, California, USA.
Padraig Gearoid
PG
O'Neill
D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001282:Atrial Flutter / Q000209:etiology; D001938:Brazil; D017115:Catheter Ablation / Q000009:adverse effects; D003452:Cryosurgery / Q000009:adverse effects / Q000295:instrumentation*; D018572:Disease-Free Survival; D004867:Equipment Design; D005260:Female; D006339:Heart Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009864:Ontario; D061646:Operative Time; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D015641:Radiography, Interventional; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013617:Tachycardia, Supraventricular / Q000209:etiology; D007507:Therapeutic Irrigation / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
atrial fibrillation; catheter ablation; cryoablation; cryoballoon; phrenic nerve palsy