title: Cryoballoon versus Radiofrequency Catheter Ablation in Atrial Fibrillation: A Meta-Analysis.
abstract: Radiofrequency (RF) and cryoballoon (CB) catheter ablation are effective for pulmonary vein isolation (PVI) in atrial fibrillation (AF). This report presents an updated meta-analysis comparing the efficacy and safety of CB versus RF ablations in AF.
  
  
  
  Databases and conference abstracts were systematically searched for studies that directly compared CB and RF PVI, and reported safety or efficacy outcomes in follow-up ≥12 months. Recurrent atrial tachyarrhythmias (AT) were defined as AF, atrial flutter, or atrial tachycardia.
  
  
  
  Twenty-two studies and 8,668 patients were included. Freedom from AT was not significantly different between CB and RF ablations in the pooled population (OR 1.12; 95%CI 0.97-1.29; P = 0.13) and in randomized trials (OR 1.0; 95%CI 0.65-1.56; P = 0.99). Second-generation CB (CB2; 78.1%) and contact-force (CF) sensing RF (78.2%) have improved procedure success rate as compared to first-generation technology (57.9% CB, 58.1% RF). As compared to CF-RF, CB2 demonstrated similar freedom from recurrent AT (OR 1.04; 95%CI 0.71-1.51; P = 0.84). The incidence of pericardial effusions (OR 0.44; 95%CI 0.28-0.69; P < 0.01), tamponade (OR 0.31; 95%CI 0.15-0.64; P < 0.01), and non-AF AT (OR 0.46; 95%CI 0.26-0.83; P < 0.01) were significantly lower with CB ablation, whereas transient phrenic nerve palsy was more incident after CB (OR 7.40; 95%CI 2.56-21.34; P < 0.01).
  
  
  
  There was comparable freedom from AT between CB and RF in patients with AF undergoing PVI. Additionally, freedom from AT was similar between CB2 and CF-RF. However, CB was associated with a lower incidence of pericardial effusions or tamponade, albeit with a higher rate of transient phrenic nerve palsies.
authors.affiliation: Division of Cardiology, Department of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida, USA. rhmncardoso@gmail.com.
authors.forename: Rhanderson
authors.initials: R
authors.lastname: Cardoso
authors.affiliation: Division of Cardiology, Department of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida, USA.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Mendirichaga
authors.affiliation: Division of Cardiology, Department of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida, USA.
authors.forename: Gilson
authors.initials: G
authors.lastname: Fernandes
authors.affiliation: Division of Cardiology, Department of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida, USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Healy
authors.affiliation: Division of Cardiology, Department of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida, USA.
authors.forename: Litsa K
authors.initials: LK
authors.lastname: Lambrakos
authors.affiliation: Division of Cardiology, Department of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida, USA.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Viles-Gonzalez
authors.affiliation: Division of Cardiology, Department of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Goldberger
authors.affiliation: Division of Cardiology, Department of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida, USA.
authors.forename: Raul D
authors.initials: RD
authors.lastname: Mitrani
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001282:Atrial Flutter / Q000209:etiology; D002305:Cardiac Tamponade / Q000209:etiology; D017115:Catheter Ablation / Q000009:adverse effects; D016009:Chi-Square Distribution; D003452:Cryosurgery / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010243:Paralysis / Q000209:etiology; D010490:Pericardial Effusion / Q000209:etiology; D059348:Peripheral Nerve Injuries / Q000209:etiology; D010791:Phrenic Nerve / Q000293:injuries; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors; D013617:Tachycardia, Supraventricular / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
keywords: atrial fibrillation; catheter ablation; complication; cryoballoon; pulmonary vein isolation; radiofrequency