Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation

• Published in: The New England journal of medicine Vol. 374; no. 23; pp. 2235 - 2245
• Main Authors: Kuck, Karl-Heinz, Brugada, Josep, Fürnkranz, Alexander, Metzner, Andreas, Ouyang, Feifan, Chun, K.R. Julian, Elvan, Arif, Arentz, Thomas, Bestehorn, Kurt, Pocock, Stuart J, Albenque, Jean-Paul, Tondo, Claudio
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 09-06-2016
• Subjects: Ablation; Aged; Arrhythmia; Atrial Fibrillation - surgery; Cardiac arrhythmia; Catheter Ablation - instrumentation; Catheter Ablation - methods; Catheters; Cryosurgery - methods; Disease-Free Survival; Female; Fibrillation; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Male; Medical procedures; Middle Aged; Patients; Postoperative Complications; Radiofrequency ablation; Recurrence; Reoperation; Safety; Single-Blind Method; Tachycardia; Veins & arteries; Germany
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa1602014

Over 700 patients with drug-refractory paroxysmal atrial fibrillation were randomly assigned to cryoballoon or radiofrequency ablation. Cryoballoon ablation was noninferior to radiofrequency for the composite of recurrent atrial arrhythmia, use of antiarrhythmic drugs, or repeat ablation.
According to a 2012 expert consensus statement, catheter ablation of drug-refractory paroxysmal atrial fibrillation is a class I level A indication,
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and pulmonary-vein isolation is the standard approach.
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–
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The two most frequently used ablation technologies for pulmonary-vein isolation differ in the energy source and mode of application. The most common method is the use of radiofrequency current applied in a point-by-point mode, which leads to cellular necrosis by tissue heating; the other method is the use of cryogenic energy applied with a balloon in a single-step mode, which leads to necrosis by freezing (Figure 1). Radiofrequency ablation for atrial . . .