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. 2016 Oct 31;9(3):1429.
doi: 10.4022/jafib.1429. eCollection 2016 Oct-Nov.

Cryoballoon versus Radiofrequency Ablation for Atrial Fibrillation: A Meta-analysis of 16 Clinical Trials

Jalaj Garg  1 , Rahul Chaudhary  2 , Chandrasekar Palaniswamy  3 , Neeraj Shah  1 , Parasuram Krishnamoorthy  4 , Babak Bozorgnia  1 , Andrea Natale  5
Affiliations

Cryoballoon versus Radiofrequency Ablation for Atrial Fibrillation: A Meta-analysis of 16 Clinical Trials

Jalaj Garg et al. J Atr Fibrillation. .

Abstract

Introduction: We aimed to study the procedural characteristics, efficacy and safety of cryoballoon ablation (CBA) versus radiofrequency ablation (RFA) for catheter ablation of paroxysmal atrial fibrillation (AF). Methods: A systematic literature search was performed using PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials to clinical trials comparing CBA and RFA for AF. Outcomes were evaluated for efficacy, procedure characteristics and safety. For each study, odd ratio (OR) and 95% confidence intervals (CIs) were calculated for endpoints for both approaches. Results: We analyzed a total of 9,957 participants (3,369 in the CBA and 6,588 in RFA group) enrolled in 16 clinical trials. No significant difference was observed between CBA and RFA with regards to freedom from atrial arrhythmia at 12-months, recurrent atrial arrhythmias or repeat catheter ablation. CBA group had a significantly higher transient phrenic nerve injury (OR 14.19, 95% CI: 6.92-29.10; p<0.001) and persistent phrenic nerve injury (OR 4.62, 95% CI: 1.97-10.81; p<0.001); and a significantly lower pericardial effusion/cardiac tamponade (OR 0.43, 95% CI: 0.26-0.72; p=0.001), and groin site complications (OR 0.60, 95% CI: 0.38-0.93; p=0.02). No significant difference was observed in overall complications, stroke/thromboembolic events, major bleeding, and minor bleeding. Conclusion: CBA was non-inferior to RFA for catheter ablation of paroxysmal AF. RF ablation was associated with a higher groin complications and pericardial effusion/cardiac tamponade, whereas CBA was associated with higher rates of transient and persistent phrenic nerve injury.

Keywords: Atrial Fibrillation; Catheter Ablation; Cryoballoon; Radiofrequency.

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Figures

Figure 1.
Figure 1.. Process of study selection for randomized and prospective trials
Supplementary Figure 1.
Supplementary Figure 1.. Funnel plots evaluating publication bias in all studies: a) Freedom from atrial arrhythmias at 12 months; b) Recurrent atrial arrhythmias; c) Repeat ablation within 12 months since index ablation; d) Overall acute complications
Figure 2.
Figure 2.. Forest plot demonstrating primary efficacy outcomes in patients with atrial fibrillation undergoing cryoablation versus radiofrequency ablation
Figure 3.
Figure 3.. Forest plot demonstrating procedural outcomes of cryoablation versus radiofrequency ablation
Figure 4.
Figure 4.. Forest plot demonstrating all-cause mortality in patients with atrial fibrillation undergoing cryoablation versus radiofrequency ablation
Figure 5A.
Figure 5A.. Forest plot demonstrating safety outcomes - overall acute complications, stroke/thromboembolism, major bleeding, minor bleeding and groin site complications in patients with atrial fibrillation undergoing cryoablation versus radiofrequency ablation
Figure 5B.
Figure 5B.. Forest plot demonstrating safety outcomes - transient and unresolved phrenic nerve injury, pericardial effusion/tamponade and pulmonary vein stenosis in patients with atrial fibrillation undergoing cryoablation versus radiofrequency ablation
Supplementary Figure 2.
Supplementary Figure 2.. Forest plot demonstrating primary efficacy endpoints (randomized controlled trials only) in patients with atrial fibrillation undergoing cryoablation versus radiofrequency ablation
Supplementary Figure 3.
Supplementary Figure 3.. Forest plot demonstrating procedural outcomes (randomized controlled trials only) in patients with atrial fibrillation undergoing cryoablation versus radiofrequency ablation
Supplementary Figure 4.
Supplementary Figure 4.. Forest plot demonstrating safety outcomes (randomized controlled trials only) - overall acute complications, groin site complications, transient and unresolved phrenic nerve injury and pericardial effusion/tamponade in patients with atrial fibrillation undergoing cryoablation versus radiofrequency ablation
Supplementary Figure 5.
Supplementary Figure 5.. Forest plot demonstrating primary efficacy endpoints in studies evaluating 2nd generation CBA catheter versus contact-sensing RFA catheter
Supplementary Figure 6.
Supplementary Figure 6.. Forest plot demonstrating procedural outcomes in studies evaluating 2nd generation CBA catheter versus contact-sensing RFA catheter
Supplementary Figure 7.
Supplementary Figure 7.. Forest plot demonstrating safety outcomes – overall acute complications, groin site complications and transient phrenic nerve injury in studies evaluating 2nd generation CBA catheter and contact-sensing RFA catheter
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