Results from a multicentre comparison of cryoballoon vs. radiofrequency ablation for paroxysmal atrial fibrillation: is cryoablation more reproducible?
OBJECTIVE
Cryoballoon ablation (Cryoballoon) has emerged as a new alternative for the treatment of symptomatic drug-refractory atrial fibrillation (AF). Whether the results of Cryoballoon are more reproducible than those of radiofrequency (RF) ablation remains to be proved.


RESULTS
A total of 860 consecutive patients undergoing a first ablation procedure for paroxysmal AF (467 treated with RF and 393 treated with Cryoballoon) were selected from a prospective multicentre survey of AF ablation (FrenchAF). Radiofrequency and Cryoballoon were compared regarding mid-term efficacy and safety. During a median follow-up of 14 months (interquartile range 8-23), patients treated with Cryoballoon displayed similar rates of freedom from atrial arrhythmia relapse in centres performing this technique (68-80% at 18 months). However, in centres performing RF, a greater heterogeneity in procedural results was observed (46-79% were free from atrial arrhythmia relapse at 18 months). On multivariate analysis, Cryoballoon (HR = 0.47, 95% CI 0.35-0.65, P < 0.001) and annual AF ablation caseload (HR = 0.87 per every 100 AF ablation procedures per year; 95% CI 0.80-0.96, P = 0.003) were independent predictors of procedural success. However, on sensitivity analysis, according to the ablation method, annual AF ablation caseload predicted only sinus rhythm maintenance in the subgroup of patients treated with RF. Analysis of interoperator results with Cryoballoon and RF confirmed lower reproducibility of RF, but suggested that besides caseload, other operator-related factors may play a role.


CONCLUSIONS
Cryoballoon seems to be less operator-dependent and more reproducible than RF in the setting of paroxysmal AF ablation.
Département de Rythmologie, Clinic Pasteur of Toulouse, 45 avenue de Lombez, BP 27617, Toulouse Cedex 3 31076, France rui_providencia@yahoo.com.|Barts Health NHS Trust, London, UK.
Rui
R
Providencia
University Hospital of Grenoble, Grenoble, France.
Pascal
P
Defaye
Barts Health NHS Trust, London, UK.
Pier D
PD
Lambiase
Hospital Pontchaillou of Rennes, Rennes, France.
Dominique
D
Pavin
Nouvelles Cliniques Nantaises, Nantes, France.
Jean-Pierre
JP
Cebron
Hopital Prive Parly 2, Le Chesnay, Paris, France.
Franck
F
Halimi
University Hospital of Rouen, Rouen, France.
Frédéric
F
Anselme
Barts Health NHS Trust, London, UK.
Neil
N
Srinivasan
Département de Rythmologie, Clinic Pasteur of Toulouse, 45 avenue de Lombez, BP 27617, Toulouse Cedex 3 31076, France.
Jean-Paul
JP
Albenque
Département de Rythmologie, Clinic Pasteur of Toulouse, 45 avenue de Lombez, BP 27617, Toulouse Cedex 3 31076, France.
Serge
S
Boveda
D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation; D016009:Chi-Square Distribution; D002983:Clinical Competence; D003452:Cryosurgery / Q000009:adverse effects / Q000295:instrumentation; D018572:Disease-Free Survival; D004867:Equipment Design; D005260:Female; D005602:France; D019538:Health Care Surveys; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D016526:Workload
Arrhythmia; Atrial fibrillation; Catheter ablation; Cryoballoon; Efficacy; Radiofrequency ablation; Safety