Efficacy and safety of the second-generation cryoballoons versus radiofrequency ablation for the treatment of paroxysmal atrial fibrillation: a systematic review and meta-analysis.
OBJECTIVE
Currently, radiofrequency (RF) and cryoballoon are the most commonly used ablation technologies for atrial fibrillation (AF). We performed a meta-analysis to assess the efficacy and safety of the second-generation cryoballoons (CB-2) compared with RF for paroxysmal atrial fibrillation (PAF) ablation.


METHODS
The PubMed, Cochrane Library, and Embase databases were searched and qualified studies were identified. The primary clinical outcome was the recurrence rate of atrial tachyarrhythmia (AT), and the secondary clinical outcomes were procedure time, fluoroscopy time, and the complications that followed.


RESULTS
Nine observational studies (2336 patients) with a mean follow-up period ranging from 8.8 to 16.8 months were included. The CB-2 group was associated with a significantly lower recurrence rate of ATs (20.8 versus 29.8 %, p = 0.01). In subgroup analysis, compared with non-contact force sensing (NCF) catheter, using CB-2 showed significantly reduced incidence of ATs (22.0 versus 38.5 %, p < 0.00001). However, the difference became negligible in contrast with contact force sensing (CF) catheter. Moreover, the CB-2 group had a tendency to decrease procedure time (weighted mean difference -39.72 min, p = 0.0003), whereas fluoroscopy time was similar between the two groups. The total complication rate showed no statistical difference (8.8 versus 4.4 %, p = 0.08). Almost all the cases of phrenic nerve palsy occurred in the CB-2 group, whereas pericardial tamponade was seldom manifested in the CB-2 group.


CONCLUSIONS
CB-2 tended to be more effective in comparison to NCF catheter and at least non-inferior to CF catheter, with shorter procedure time and similar safety endpoint.
Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi Autonomous Region, People's Republic of China.
Jingbo
J
Jiang
Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi Autonomous Region, People's Republic of China.
Jinyi
J
Li
Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, 22 Shuangyong Road, Nanning, 530021, Guangxi Autonomous Region, People's Republic of China. zhonggqgxmu@163.com.
Guoqiang
G
Zhong
Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, People's Republic of China.
Junjun
J
Jiang
D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation; D003452:Cryosurgery / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control*; D015995:Prevalence; D012307:Risk Factors; D016896:Treatment Outcome
Atrial fibrillation; Cryoballoon; Meta-analysis; Radiofrequency ablation
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