title: Outcomes after cryoballoon or radiofrequency ablation for persistent atrial fibrillation: a multicentric propensity-score matched study.
abstract: OBJECTIVE
  Recent data show no benefit of additional ablation beyond pulmonary vein isolation (PVI) in persistent atrial fibrillation (AF). Evidence suggests that radiofrequency energy (RF) and cryoballoon (CRYO) have comparable efficacy for PVI. We aimed to assess the outcomes after a single catheter ablation procedure, comparing PVI using CRYO vs. RF ablation for PVI plus additional ablation in a cohort of patients with persistent AF.
  
  
  METHODS
  In this prospective multicenter propensity score-matched comparison, 59 consecutive patients undergoing CRYO ablation of persistent AF were matched to 59 patients treated with RF from November 2010 to June 2012.
  
  
  RESULTS
  During a mean follow-up of 15.6 ± 11.5 months, 43.2 % of patients presented atrial arrhythmia relapse after a blanking period of 3 months, which was comparable between the two groups (40.7 % in CRYO vs. 45.8 % in RF, Log rank P = 0.14; HR = 0.67, 95 %CI 0.38-1.16, P = 0.15), despite the fact that 52.5 % of RF patients add additional complex fractionated atrial electrogram ablation, as well as left atrial linear ablation in over two-thirds (roof line in 67.8 % and mitral isthmus in 32.2 %). On multivariate Cox regression, only AF duration in years (HR = 1.10, 95 %CI 1.01-1.10, P = 0.04) was a predictor of relapse. Patients undergoing RF ablation presented a numerically, but non-significantly, lower complication rate (6.8 vs 10.2 %, P = 0.51).
  
  
  CONCLUSIONS
  In our multicenter experience, freedom from atrial arrhythmias was comparable among matched patients treated with CRYO and RF, despite non-significant trends in favor of RF in terms of complications, at the cost of longer procedure times.
authors.affiliation: Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076, Toulouse Cedex 3, France. s.boveda@clinique-pasteur.com.
authors.forename: Serge
authors.initials: S
authors.lastname: Boveda
authors.affiliation: Barts Heart Centre, Barts Health NHS Trust, London, UK.
authors.forename: Rui
authors.initials: R
authors.lastname: Providência
authors.affiliation: University Hospital Michallon, Grenoble, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Defaye
authors.affiliation: University Hospital Pontchaillou, Rennes, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Pavin
authors.affiliation: Nouvelles Cliniques Nantaises, Nantes, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Cebron
authors.affiliation: University Hospital, Rouen, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Anselme
authors.affiliation: Hôpital Privé Parly 2, Le Chesnay, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Halimi
authors.affiliation: University Hospital Arnaud de Villeneuve, Montpellier, France.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Khoueiry
authors.affiliation: Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076, Toulouse Cedex 3, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Combes
authors.affiliation: Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076, Toulouse Cedex 3, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Combes
authors.affiliation: Institut de Radioprotection et de Sureté Nucléaire, PRP-HOM, SRBE, LEPID, Laboratoire d'Epidémiologie, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Jacob
authors.affiliation: Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076, Toulouse Cedex 3, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Albenque
authors.affiliation: Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076, Toulouse Cedex 3, France.
authors.forename: Pedro
authors.initials: P
authors.lastname: Sousa
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D017115:Catheter Ablation / Q000401:mortality* / Q000706:statistics & numerical data*; D002908:Chronic Disease; D017679:Cryotherapy / Q000401:mortality* / Q000706:statistics & numerical data*; D018572:Disease-Free Survival; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality* / Q000517:prevention & control; D015995:Prevalence; D057216:Propensity Score; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Arrhythmia relapse; Atrial fibrillation; Cryoballoon ablation; Pulmonary vein isolation; Radiofrequency ablation