Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Apr 1:2018:6276241.
doi: 10.1155/2018/6276241. eCollection 2018.

Radiofrequency Ablation versus Cryoablation in the Treatment of Paroxysmal Atrial Fibrillation: A Meta-Analysis

Ali H Hachem  1 , Joseph E Marine  2 , Housam A Tahboub  1 , Sana Kamdar  1 , Shaffi Kanjwal  1 , Ronak Soni  1 , Khalil Kanjwal  3
Affiliations
Review

Radiofrequency Ablation versus Cryoablation in the Treatment of Paroxysmal Atrial Fibrillation: A Meta-Analysis

Ali H Hachem et al. Cardiol Res Pract. .

Abstract

Background: Pulmonary vein isolation is commonly performed using radiofrequency energy with cryoablation gaining acceptance. We performed a meta-analysis of randomized controlled trials which compared radiofrequency versus cryoablation for patients with atrial fibrillation.

Methods: A systematic search strategy identified both published and unpublished articles from inception to November 10, 2016, in multiple databases. The primary outcomes for this meta-analysis were long-term freedom from atrial fibrillation at 12-month follow-up and overall postoperative complication rates. For all included studies, the methodological quality was assessed through the Cochrane Collaboration's tool for risk of bias.

Results: A total of 247 articles were identified with eight being included in this review as they satisfied the prespecified inclusion criteria. Overall, there was no significant difference in freedom from atrial fibrillation at ≥12-month follow-up between those receiving cryoballoon and radiofrequency ablation, respectively (OR = 0.98, CI = 0.67-1.43, I2 = 56%, p=0.90). Additionally, the secondary outcomes of duration of ablation, fluoroscopy time, and ablation time failed to reach significance. Cryoballoon ablation had significantly greater odds of postoperative phrenic nerve injury at 12-month follow-up.

Conclusions: Our meta-analysis suggests that cryoballoon ablation provides comparable benefits with regard to freedom from atrial fibrillation at medium-term follow-up, fluoroscopy time, ablation time, operative duration, and overall complication rate in comparison to radiofrequency ablation.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow diagram of study inclusion.
Figure 2
Figure 2
Risk of bias of included studies in the meta-analysis.
Figure 3
Figure 3
Funnel plot for assessment of publication bias for freedom from atrial fibrillation at 12-month follow-up.
Figure 4
Figure 4
Funnel plot for overall postoperative complication rate.
Figure 5
Figure 5
Mean odds ratio with 95% CI of patients free from atrial fibrillation at ≥12-month follow-up.
Figure 6
Figure 6
Mean procedure time in minutes with 95% CI of patients receiving cryoballoon versus radiofrequency ablation.
Figure 7
Figure 7
Mean fluoroscopy time in minutes with 95% CI in patients receiving cryoballoon versus radiofrequency ablation.
Figure 8
Figure 8
Mean ablation time in minutes with 95% CI in patients receiving cryoballoon versus radiofrequency ablation.
Figure 9
Figure 9
Mean odds ratio of overall postoperative complications with 95% CI in patients receiving cryoballoon versus radiofrequency ablation.
See this image and copyright information in PMC

References

    1. Camm A. J., Lip G. Y. H., De Caterina R., et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. European Heart Journal. 2012;33(21):2719–2747. doi: 10.1093/eurheartj/ehs253. - DOI - PubMed
    1. Carter L., Gardner M., Magee K., et al. An integrated management approach to atrial fibrillation. Journal of the American Heart Association. 2016;5(1):p. e002950. doi: 10.1161/JAHA.115.002950. - DOI - PMC - PubMed
    1. Magnani J. W., Rienstra M., Lin H., et al. Atrial fibrillation: current knowledge and future directions in epidemiology and genomics. Circulation. 2011;124(18):1982–1993. doi: 10.1161/CIRCULATIONAHA.111.039677. - DOI - PMC - PubMed
    1. Skelly A., Hashimoto R., Al-Khatib S., et al. Catheter Ablation for Treatment of Atrial Fibrillation. Rockville, MD, USA: Agency for Healthcare Research and Quality; 2015. http://www.ncbi.nlm.nih.gov/books/NBK305760. - PubMed
    1. Luik A., Radzewitz A., Kieser M., et al. Cryoballoon versus open irrigated radiofrequency ablation in patients with paroxysmal atrial fibrillation: the prospective, randomized, controlled, noninferiority freeze AF study. Circulation. 2015;132(14):1311–1319. doi: 10.1161/circulationaha.115.016871. - DOI - PMC - PubMed

LinkOut - more resources