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Atrial Fibrillation Ablation - Cryoballoon versus Radiofrequency: A Meta-analysis of 20 Clinical Trials

Introduction: We aimed to study the efficacy, procedural characteristics and safety of cryoablation (CBA) versus radiofrequency (RFA) ablation in patients with drug refractory paroxysmal atrial fibrillation. 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 and 95% confidence intervals (CIs) were calculated for endpoints for both approaches. Results: We included a total of 10,463 participants (3,576 in the CBA and 6,887 in RFA group) enrolled in 20 clinical trials. No significant difference was observed between CBA and RFA in freedom from atrial arrhythmia at 12-months, recurrent atrial arrhythmias or repeat ablation. CBA group had significantly increased transient phrenic nerve injury (OR 8.37, 95% CI 3.52-19.87; p<0.00001) and persistent phrenic nerve injury (OR 7.94, 95% CI 3.51-17.94; p<0.00001); with significant reduction in pericardial effusion/cardiac tamponade (OR 0.50, 95% CI 0.33-0.76; p=0.001), and groin site complications (OR 0.62, 95% CI 0.40-0.96; p=0.03). There was no significant difference was observed in stroke/thromboembolic event, major bleeding, minor bleeding and pulmonary vein stenosis. Conclusion: Cryoablation was non-inferior to RFA in patients with drug refractory paroxysmal atrial fibrillation. Radiofrequency ablation was associated with increased groin complications and pericardial effusion/cardiac tamponade, whereas CBA was associated with transient and persistent phrenic nerve injury.

Credits: Jalaj Garg MD FESC; Rahul Chaudhary MD; Chandrasekar Palaniswamy MD; Neeraj Shah MD MPH; Babak Bozorgnia MD FACC; Andrea Natale MD FACC FHRS FESC

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