First-line catheter ablation of paroxysmal atrial fibrillation: outcome of radiofrequency vs. cryoballoon pulmonary vein isolation.
OBJECTIVE
First-line ablation prior to antiarrhythmic drug (AAD) therapy is an option for symptomatic paroxysmal atrial fibrillation (PAF); however, the optimal ablation technique, radiofrequency (RF), or cryoballoon (CB) has to be determined.


RESULTS
The FREEZE Cohort Study compares RF and CB ablation. Treatment-naïve patients were documented in the FREEZEplus Registry. Periprocedural data and outcome were analysed. From 2011 to 2014, a total of 373/4184 (8.9%) patients with PAF naïve to AAD were identified. Pulmonary vein isolation (PVI) was performed with RF (n = 180) or CB (n = 193). In the RF group, patients were older (65 vs. 61 years, P < 0.01) compared with the CB group. The procedure time was significantly shorter and radiation exposure higher in the CB group. Major adverse events occurred in 1.6% (CB) and 3.7% (RF) of patients (P = 0.22). AF/atrial tachycardia (AT) recurrence until discharge was 4.5% (RF) and 8.5% (CB, P = 0.2). Follow-up (FU) ≥12 months was available in 99 (RF) and 107 (CB) patients. After 1.4 years of FU, freedom from AF/atrial tachycardia (AT) was 61% (RF) and 71% (CB, P = 0.11). In the RF group, more patients underwent cardioversion, and a trend for more repeat ablations was observed. Persistent phrenic nerve palsy was observed in one patient treated by CB.


CONCLUSIONS
First-line ablation for PAF is safe and effective with either RF or CB. The procedure was faster with the CB, but the radiation exposure was higher. Although there was a trend for more recurrences and complications in the RF group, a more favourable risk profile in patients undergoing CB ablation might have biased the results.


BACKGROUND
NCT01360008.
Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Englschalkinger Str. 77, 81925 Munich, Germany florian.straube@web.de florian.straube@klinikum-muenchen.de.
Florian
F
Straube
Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Englschalkinger Str. 77, 81925 Munich, Germany.
Uwe
U
Dorwarth
Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
Sonia
S
Ammar-Busch
KRH Klinikum Siloah-Oststadt-Heidehaus, Hannover, Germany.
Timo
T
Peter
Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany.
Georg
G
Noelker
Klinikum Frankfurt Höchst GmbH, Frankfurt Main, Germany.
Thomas
T
Massa
Kerckhoff-Klinik GmbH, Bad Nauheim, Germany.
Malte
M
Kuniss
Vivantes Klinikum Am Urban, Berlin, Germany.
Niels Christian
NC
Ewertsen
Cardioangiologisches Centrum Bethanien, CCB, Frankfurt a.M., Germany.
Kyoung Ryul Julian
KR
Chun
Helios Klinikum Hildesheim, Hildesheim, Germany.
Juergen
J
Tebbenjohanns
Asklepios St Georg Hospital, Hamburg, Germany.
Roland
R
Tilz
Asklepios St Georg Hospital, Hamburg, Germany.
Karl Heinz
KH
Kuck
Stiftung Institut fuer Herzinfarktforschung, IHF Foundation, Ludwigshafen, Germany.
Taoufik
T
Ouarrak
Stiftung Institut fuer Herzinfarktforschung, IHF Foundation, Ludwigshafen, Germany.
Jochen
J
Senges
Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Englschalkinger Str. 77, 81925 Munich, Germany.
Ellen
E
Hoffmann
D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D003452:Cryosurgery / Q000009:adverse effects; D005060:Europe; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D011829:Radiation Dosage; D000069079:Radiation Exposure; D012008:Recurrence; D012042:Registries; D012086:Reoperation; D012307:Risk Factors; D013019:South Africa; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
Catheter ablation; Clinical outcome; Cryoballoon; Efficacy; First-line; Paroxysmal atrial fibrillation; Radiofrequency ablation; Safety