Cryoballoon versus radiofrequency ablation for persistent atrial fibrillation: an updated systematic review and meta‑analysis

Abstract

Background: Compared with paroxysmal atrial fibrillation, persistent atrial fibrillation (AF) is more harmful and difficult to treat, and the efficacy of different catheter ablation for both also varies greatly. So this study aimed to systematically evaluate the efficacy and safety of cryoballoon (CB) and radiofrequency (RF) ablation in the treatment of persistent AF.

Methods: We searched the PubMed, Embase, and Cochrane library databases for studies comparing the efficacy and safety between CB and RF ablation for persistent AF. All included studies met our inclusion criteria.

Results: A total of 11 studies, 2551 patients were enrolled in this study, including 1256 patients in CB group and 1295 patients in RF group. Meta-analysis results showed that the freedom from atrial tachyarrhythmia (ATA) recurrence was similar between the CB and RF groups (OR 1.00, 95% CI 0.85 to 1.18, I² 16%). The results of repeated ablation events in the two groups were similar (OR 0.85, 95% CI 0.64 to 1.12, I²45%), while the operative time in the CB group was shorter than that in the RF group (mean reduction 45.27 min, 95% CI 61.34 to 29.20 min, I² 95%). There was no significant difference in fluoroscopy time between the two groups (mean difference 2.12 min, 95% CI 7.83 to 12.07 min, I² 99%). The incidence of total complications was similar between the two groups (OR 1.08, 95% CI 0.74 to 1.58, I² 0%), but phrenic nerve palsy (PNP) was more likely to occur in the CB group (OR 4.84, 95% CI 1.84 to 12.71, I² 0%). The incidence of pericardial tamponade was not statistically different between the two groups (OR 0.72, 95% CI 00.32 to 1.58, I² 0%).

Conclusions: CB can be used as an alternative therapy to RF for persistent AF, both of which have considerable efficacy and safety. CB can significantly reduce the operation time with the probability of high PNP.

Keywords: Cryoballoon ablation; Meta-analysis; Persistent atrial fibrillation; Radiofrequency ablation.

Fig. 1

PRISMA Flow Diagram

Fig. 2

Freedom from recurrent ATA with RF vs. CB ablation

Fig. 3

Repeat ablation with RF vs. CB ablation

Fig. 4

A Total procedural time with RF vs. CB ablation; B: Fluoroscopy time with RF vs. CB ablation

Fig. 5

A Total complications with RF vs. CB ablation; B: PNP with RF vs. CB ablation; C: Cardiac tamponade with RF vs. CB ablation

Fig. 6

A Subgroup analysis for freedom from ATA by trial RF ablation strategy (PVI only or additional ablation permitted) B: Subgroup analysis for procedure time by trial RF ablation strategy (PVI only or additional ablation permitted) C: Subgroup analysis for fluoroscopy time by trial RF ablation strategy (PVI only or additional ablation permitted)