Comparison between radiofrequency with contact force-sensing and second-generation cryoballoon for paroxysmal atrial fibrillation catheter ablation: a multicentre European evaluation

• Published in: Europace (London, England) Vol. 17; no. 5; pp. 718 - 724
• Main Authors: Squara, Fabien, Zhao, Alexandre, Marijon, Eloi, Latcu, Decebal Gabriel, Providencia, Rui, Di Giovanni, Giacomo, Jauvert, Gaël, Jourda, Francois, Chierchia, Gian-Battista, De Asmundis, Carlo, Ciconte, Giuseppe, Alonso, Christine, Grimard, Caroline, Boveda, Serge, Cauchemez, Bruno, Saoudi, Nadir, Brugada, Pedro, Albenque, Jean-Paul, Thomas, Olivier
• Format: Journal Article
• Language: English
• Published: England 01-05-2015
• Subjects: Aged; Atrial Fibrillation - diagnosis; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Cardiac Catheters; Catheter Ablation - adverse effects; Catheter Ablation - instrumentation; Cryosurgery - adverse effects; Cryosurgery - instrumentation; Disease-Free Survival; Equipment Design; Europe; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Postoperative Complications - etiology; Prospective Studies; Pulmonary Veins - physiopathology; Pulmonary Veins - surgery; Recurrence; Retrospective Studies; Risk Factors; Time Factors; Transducers, Pressure; Treatment Outcome; Europe; Radiofrequency; Ablation; Cryoballoon; Atrial fibrillation
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/euv060

Whether pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) using contact force (CF)-guided radiofrequency (RF) or second-generation cryoballoon (CB) present similar efficacy and safety remains uncertain.
We performed a multicentre study comparing procedural safety and arrhythmia recurrence after standardized PVI catheter ablation for PAF using CF-guided RF ablation (Thermocool(®) SmartTouch™, Biosense Webster; or Tacticath™, St Jude Medical) (CF group) with second-generation CB ablation (Arctic Front Advance™, Medtronic) (CB group). Overall, 376 patients (mean age 59.8 ± 10.4 years, 280 males) were enrolled in 4 centres: 198 in CF group and 178 in CB group. Procedure was shorter for CB group than for CF group (109.6 ± 40 vs. 122.5 ± 40.7 min, P = 0.003), but fluoroscopy duration and X-ray exposure were not statistically different (P = 0.1 and P = 0.22, respectively). Overall complication rate was similar in both groups: 14 (7.1%) in the CF group vs. 13 (7.3%) in the CB group (P = 0.93). However, transient right phrenic nerve palsy occurred only in CB group (10 patients, 5.6%; P = 0.001 vs. CF group) and severe non-lethal complications (embolic event, tamponade, or oesophageal injury) occurred only in CF group (5 patients, 2.5%; P = 0.03 vs. CB group). No periprocedural death occurred in either group. Single-procedure freedom from any atrial arrhythmias at 18 months post-ablation was comparable in CF group and CB group (76 vs. 73.3%, respectively, log rank P = 0.63).
Pulmonary vein isolation using CF-guided RF and second-generation CB leads to comparable single-procedure arrhythmia-free survival at up to 18 months with similar overall complication rate.