title: Point-by-Point Radiofrequency Ablation Versus the Cryoballoon or a Novel Combined Approach: A Randomized Trial Comparing 3 Methods of Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation (The Cryo Versus RF Trial).
abstract: BACKGROUND
  Catheter ablation of paroxysmal AF using the Cryoballoon (CRYO) has yielded similar success rates to conventional wide encirclement using radiofrequency catheter ablation (RFCA), but randomized data are lacking. Pilot data suggested a high success rate with a combined approach (COMBINED) using wide encirclement with RFCA followed by 2 CRYO applications to each vein. We compared these 3 strategies in a randomized controlled trial.
  
  
  RESULTS
  Patients undergoing first time paroxysmal AF ablation were randomized to RFCA, CRYO, or COMBINED. Patients were followed up at 3, 6, and 12 months with 7 days of ambulatory ECG monitoring. Success was defined as freedom from arrhythmia without antiarrhythmic drugs after a single procedure. A total of 237 patients were randomized. Success at 1 year was achieved in 47% in the RFCA group, 67% in the CRYO group, and 76% in the COMBINED group (P < 0.001 for RFCA vs. CRYO, P<0.001 for RFCA vs. COMBINED, and P = 0.220 for CRYO vs. COMBINED). Procedure time was 211 (IQR 174-256) minutes for RFCA compared to 167 (136-202) minutes for CRYO and 278 (243-327) minutes for COMBINED (P < 0.001 for RFCA vs. COMBINED, RFCA vs. CRYO, and CRYO vs. COMBINED groups).
  
  
  CONCLUSIONS
  Pulmonary vein isolation for paroxysmal AF is faster with CRYO and results in a higher single procedure success rate than conventional point by point RFCA. The COMBINED approach was not superior to CRYO alone.
authors.affiliation: Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Hunter
authors.affiliation: Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Baker
authors.affiliation: Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Malcolm C
authors.initials: MC
authors.lastname: Finlay
authors.affiliation: Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Duncan
authors.affiliation: Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Lovell
authors.affiliation: Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Muzahir H
authors.initials: MH
authors.lastname: Tayebjee
authors.affiliation: Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Waqas
authors.initials: W
authors.lastname: Ullah
authors.affiliation: Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
authors.forename: M Shoaib
authors.initials: MS
authors.lastname: Siddiqui
authors.affiliation: Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Ailsa
authors.initials: A
authors.lastname: McLEAN
authors.affiliation: Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Richmond
authors.affiliation: Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Kirkby
authors.affiliation: Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Ginks
authors.affiliation: Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Mehul
authors.initials: M
authors.lastname: Dhinoja
authors.affiliation: Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Sporton
authors.affiliation: Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Earley
authors.affiliation: Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Schilling
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D003131:Combined Modality Therapy; D003452:Cryosurgery / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D015716:Electrocardiography, Ambulatory; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: atrial fibrillation; catheter ablation; cryoballoon; pulmonary vein isolation