uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Cryoballoon versus radiofrequency ablation for atrial fibrillation – a study of outcome and safety based on the ESC-EHRA atrial fibrillation ablation long-term registry and the Swedish Catheter ablation registry
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
Show others and affiliations
2018 (English)In: Europace, ISSN 1099-5129, E-ISSN 1532-2092Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aims

Pulmonary vein isolation (PVI), the standard for atrial fibrillation (AF) ablation, is most commonly applied with radiofrequency (RF) energy, although cryoballoon technology (CRYO) has gained widespread use. The aim was to compare the second generation cryoballoon and the irrigated RF energy regarding outcomes and safety.

Methods

Of 4657 patients undergoing their first AF ablation, 982 with CRYO and 3675 with RF energy were included from the Swedish catheter ablation registry and the Atrial Fibrillation Ablation Long-Term registry of the European Heart Rhythm Association of the European Society of Cardiology. The primary endpoint was repeat AF ablation. The major secondary endpoints included procedural duration, tachyarrhythmia recurrence and complication rate.

Results

The re-ablation rate after 12 months was significantly lower in the CRYO versus the RF group, 7.8% versus 11%, p=0.005, while freedom from arrhythmia recurrence (30 seconds duration) did not differ between the groups, 70.2 % versus 68.2%, p=0.44. The result was not influenced by AF type and lesion sets applied. In Cox regression analysis for re-ablation paroxysmal AF had significantly lower risk with CRYO, hazard ratio 0.56 (p=0.041). Procedural duration was significantly shorter with CRYO than RF, (mean±SD) 133.6±45.2 minutes versus 174.6±58.2 minutes, p<0.001. Complication rates were similar; 53/982 (5.4%) versus 191/3675 (5.2%), CRYO versus RF, p=0.806.

Conclusion

The lower re-ablation rates and shorter procedure times observed with the cryoballoon compares favorably with RF ablation. Although there are inherent limitations with registries, our findings may have important clinical implications when choosing AF ablation technique.

Place, publisher, year, edition, pages
2018.
Keywords [en]
atrial fibrillation, ablation, radiofrequency, cryoballoon, registry
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
URN: urn:nbn:se:uu:diva-362210OAI: oai:DiVA.org:uu-362210DiVA, id: diva2:1252630
Funder
Swedish Heart Lung Foundation, 20150751Swedish Research Council, 2014-36708-117759-70Available from: 2018-10-02 Created: 2018-10-02 Last updated: 2018-10-30
In thesis
1. Outcomes and safety of new techniques for pulmonary vein isolation in patients with paroxysmal and persistent atrial fibrillation: A study based on randomised trials and registries
Open this publication in new window or tab >>Outcomes and safety of new techniques for pulmonary vein isolation in patients with paroxysmal and persistent atrial fibrillation: A study based on randomised trials and registries
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Atrial fibrillation (AF) is a common disease with a high prevalence in the adult population. Treatment of AF encompasses antiarrhythmic drugs and catheter ablation to reduce symptoms. The aim of this thesis was to study how to best alleviate symptoms of AF in a safe and efficient way comparing pharmacological treatment and the two dominating catheter ablation techniques, cryoballoon (CRYO) ablation and point-by-point radiofrequency (RF) ablation.

Quality of life improved more for those AF patients randomised to treatment with catheter ablation compared to those treated with antiarrhythmic medication after 12 months of follow up (n=155).

We evaluated a proposed optimised CRYO ablation protocol and randomised 140 patients to a single cryoballoon application per vein guided by a mapping catheter (Single cryo) or two cryoballoon applications (Routine). Acute pulmonary vein isolation rate did not differ. Procedure time decreased by 19 minutes with a lower complication rate in the Single cryo-arm. Freedom from AF after one procedure at 12 months did not differ; 73.9.0% (Single cryo) versus 71.4% (Routine).

CRYO ablation was also assessed in persistent AF and paroxysmal AF. Freedom from arrhythmia recurrence was lower after a single ablation in persistent AF (64.9%) compared with paroxysmal AF (82.2%) after 12 months. However, the reduction of AF symptoms and quality of life was excellent in both groups and did not differ after 12 months.

Patients undergoing their first AF ablation with CRYO or RF were included in a registry study. After 12 months, freedom from AF was equal irrespective of AF type, but there was a lower re-ablation rate and need for continued antiarrhythmic drug treatment after CRYO ablation. Procedure duration was reduced by 40 minutes with CRYO and complication rates did not differ,

In conclusion, catheter ablation reduces AF symptoms more than antiarrhythmic drugs and cryoballoon ablation can be further optimised with reduced procedure times and improved safety. Cryoballoon ablation is as efficacious as RF ablation as a first-line therapy in both paroxysmal and persistent AF and the lower re-ablation rates and  shorter procedure times may have important clinical implications when choosing AF ablation technique.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 81
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1509
Keywords
atrial fibrillation, antiarrhythmic drugs, ablation, cryoballoon, radiofrequency, pulmonary vein isolation, quality of life, arrhythmia monitoring, implantable cardiac monitor, atrial fibrillation burden, health economics
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-363259 (URN)978-91-513-0486-1 (ISBN)
Public defence
2018-12-05, Enghoff-salen, Akademiska sjukhuset, ingång 50, bv, Uppsala, 13:00 (English)
Opponent
Supervisors
Available from: 2018-11-14 Created: 2018-10-16 Last updated: 2018-11-30

Open Access in DiVA

No full text in DiVA

Other links

https://doi.org/10.1093/europace/euy239

Authority records BETA

Mörtsell, DavidMalmborg, HelenaBlomström-Lundqvist, Carina

Search in DiVA

By author/editor
Mörtsell, DavidMalmborg, HelenaBlomström-Lundqvist, Carina
By organisation
Cardiology-ArrhythmiaCardiology
In the same journal
Europace
Cardiac and Cardiovascular Systems

Search outside of DiVA

GoogleGoogle Scholar

urn-nbn

Altmetric score

urn-nbn
Total: 159 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf