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Review
. 2025 Feb 3;77(1):18.
doi: 10.1186/s43044-025-00611-9.

Comparative safety and effectiveness of cryoballoon versus radiofrequency ablation for atrial fibrillation: a systematic review and meta-analysis

Muhammad Furqan  1 , Ifrah Inbisat Raza  2 , Shaheera Younus  2 , Hareer Fatima  2 , Hiba Azhar  2 , Sania Kaneez Fatima  2 , Laiba Ali  2 , Sara Khan  2 , Aayat Ellahi  2
Affiliations
Review

Comparative safety and effectiveness of cryoballoon versus radiofrequency ablation for atrial fibrillation: a systematic review and meta-analysis

Muhammad Furqan et al. Egypt Heart J. .

Abstract

Background: Over the past fifty years, the incidence of atrial fibrillation (AF) has tripled. Traditionally, the main treatment for this condition has been pulmonary vein isolation (PVI) performed using radiofrequency catheter ablation (RFCA). However, another technique known as cryoballoon ablation (CBA) has been developed as another option for managing this heart rhythm disorder. This study evaluated the efficacy and safety of CBA and RFCA for the treatment of AF.

Methods: This study compared the safety and effectiveness of CBA and RFCA for the treatment of AF using a thorough review of randomized controlled trials up until June 1, 2023.

Results: The results revealed that CBA and RFCA had similar effectiveness and safety profiles in achieving freedom from AF (RR: 1.00; 95% CI: 0.93 to 1.07, p = 0.99) and paroxysmal atrial fibrillation (PAF) (RR: 0.99; 95% CI: 0.89 to 1.10, p = 0.79). CBA was faster (MD = - 23.99; 95% CI: - 32.98 to - 15.00; p < 0.00001) with a higher risk of phrenic nerve palsy (RR = 6.88; 95% CI: 3.26 to 14.50, p < 0.00001). Acute PVI rate (RR = 1.0; 95% CI: 0.99 to 1.01, p = 0.95), overall complications (RR = 1.37; 95% CI: 0.93 to 2.01, p = 0.11), pericardial effusion (RR = 0.59; 95% CI: 0.25 to 1.41, p = 0.24), and fluoroscopy time (MD = 1.63; 95% CI: - 2.06 5.32; p = 0.39) did not significantly differ between the two procedures.

Conclusions: CBA and RFCA offer similar outcomes for patients with AF and PAF, with CBA being quicker but carrying a slightly higher risk of phrenic nerve palsy.

Keywords: Atrial fibrillation; Cryoballoon; Paroxysmal atrial fibrillation; Pulmonary vein isolation; Radiofrequency ablation.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of study selection. RCT = Randomized Control Trial
Fig. 2
Fig. 2
Quality judgments about each risk of bias item
Fig. 3
Fig. 3
Forest plot for the proportion of patients free from AF in all 19 studies. AF indicates atrial fibrillation
Fig. 4
Fig. 4
Forest plot for the proportion of patients free from AF in 11 studies only containing participants with paroxysmal AF. AF indicates atrial fibrillation
Fig. 5
Fig. 5
The funnel plot for the proportion of patients free from AF. AF indicates atrial fibrillation
See this image and copyright information in PMC

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