In-hospital safety of cryoballoon and radiofrequency ablation in patients with atrial fibrillation-German nationwide analysis of more than 300,000 procedures

Abstract

Background: Pulmonary vein isolation can be performed by radiofrequency (RF) or cryoballoon (CB) ablation. Guidelines do not favor one technique, and knowledge about complication rates is limited.

Objective: We aimed to report the procedural safety of RF and CB ablation using data from a German nationwide real-world registry.

Methods: By use of health records, all left atrial catheter ablation procedures with RF or CB ablation in Germany from 2013 to 2021 were analyzed. After adjustment for confounders, safety performance end points were compared.

Results: From 2013 to 2021, RF ablation was performed in 184,616 patients and CB ablation in 118,984 patients with increasing trends in patient numbers and performing centers for both procedures. Patients with RF ablation had slightly more comorbidities. In-hospital mortality (RF, 0.08%; CB, 0.06%) and other investigated complications were rare. After adjustment for patient baseline characteristics, the risk of in-hospital mortality, serious bleeding, stroke, intracerebral bleeding, and acute kidney injury did not differ. The risk of pericardiocentesis (relative risk, 0.50; 95% confidence interval, 0.46-0.55; P < .001), vascular complication (0.36; 0.33-0.39; P < .001), and ventilation >48 hours (0.81; 0.66-0.99; P = .042) was significantly lower for CB ablation. Pericardiocentesis risk negatively correlated with annual procedure numbers per center with a faster learning curve for CB ablation (both P < .01).

Conclusion: RF and CB ablation had low overall procedural complication rates, with CB ablation showing a 50% reduced risk of pericardiocentesis. Centers with higher volume provided a better in-hospital safety with a faster learning curve for CB ablation.

Keywords: Atrial fibrillation; Cardiac tamponade; Catheter ablation; Complications; Cryoballoon; Radiofrequency; Volume outcome.