Arrhythmias and Conduction Disturbances
Comparison of Pulmonary Vein Isolation Using Cryoballoon Versus Conventional Radiofrequency for Paroxysmal Atrial Fibrillation

https://doi.org/10.1016/j.amjcard.2014.01.425Get rights and content

The aim of this study was to compare the results of pulmonary vein isolation using conventional irrigated radiofrequency (RF) approach versus the cryoballoon (CB) ablation. From January 2008 to December 2011, a total of 426 patients with drug-resistant symptomatic paroxysmal atrial fibrillation underwent pulmonary vein isolation as the index procedure by conventional manual RF or CB ablation at our center. A final population of 396 patients was considered for analysis and divided into 2 groups: conventional RF ablation (n = 260) and CB ablation (n = 136). At a mean follow-up of 23 ± 13 months (median 27, range 4 to 68), the success rate for RF ablation group was 57.3% (149 patients) and was 63.2% (86 patients) for cryoablation group (p = 0.25). Procedural times were significantly shorter in the cryoablation group (192 ± 49 vs 112 ± 58 minutes, p <0.000001) but not fluoroscopy times (36 ± 14 vs 31 ± 17 minutes, p = 0.45). No clinical predictors were found to predict atrial fibrillation recurrences. Complication rates were similar in both groups except for phrenic nerve palsy that was uniquely observed in the CB group (8.1%, p <0.00001). All phrenic nerve palsies resolved during follow-up. In conclusion, on a medium-term follow-up, conventional point-by-point RF ablation and CB ablation showed similar success rates. Procedural times were significantly shorter in the CB approach. The most frequent complication during CB procedures was phrenic nerve palsy, which occurred in 8.1% of patients and resolved in all during the follow-up period.

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Methods

From January 2008 to December 2011, all consecutive patients who underwent PV isolation as the index procedure by RF ablation or CB ablation at our department for documented symptomatic paroxysmal AF were taken into consideration for our retrospective analysis. In all procedures, the acute end point was the achievement of electrical PV isolation in all veins. Paroxysmal AF was defined as self-terminating AF episodes lasting <7 days as per guidelines. Exclusion criteria were repeat procedures

Results

In a larger series of patients, 426 consecutive patients who underwent PV isolation for paroxysmal AF as the index procedure were taken into consideration. Of these patients, 10 were excluded for impossibility to retrieve information about their follow-up, 18 because of first-line treatment, and 2 because of the occurrence of an acute complication impeding procedure termination. A total of 396 patients (279 men, 58 ± 13.3 years) were finally considered in our analysis. All patients were

Discussion

To the best of our knowledge, this is the largest study comparing conventional point-by-point RF ablation and CB ablation. The main findings of the study are that (1) no differences in terms of long-term success rates were found between RF and CB groups at a mean follow-up of 2 years, (2) CB procedures were significantly shorter, (3) periprocedural complication rates were similar in both groups, and (4) no baseline clinical characteristics appeared to predict AF recurrence.

The follow-up of 23 ±

Disclosures

Drs. Chierchia and Asmundis receive compensation for teaching purposes from AF solutions, Medtronic (Minneapolis, Minnesota). Dr. Chierchia receives compensation for proctoring purposes from AF solutions, Medtronic.

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