Comparative safety and effectiveness of cryoballoon versus radiofrequency ablation for atrial fibrillation: a systematic review and meta-analysis.

Abstract

Background: Over the past fifty years, the incidence of atrial fibrillation (AF) has tripled. Traditionally, the main treatment for this condition has been pulmonary vein isolation (PVI) performed using radiofrequency catheter ablation (RFCA). However, another technique known as cryoballoon ablation (CBA) has been developed as another option for managing this heart rhythm disorder. This study evaluated the efficacy and safety of CBA and RFCA for the treatment of AF.

Methods: This study compared the safety and effectiveness of CBA and RFCA for the treatment of AF using a thorough review of randomized controlled trials up until June 1, 2023.

Results: The results revealed that CBA and RFCA had similar effectiveness and safety profiles in achieving freedom from AF (RR: 1.00; 95% CI: 0.93 to 1.07, p = 0.99) and paroxysmal atrial fibrillation (PAF) (RR: 0.99; 95% CI: 0.89 to 1.10, p = 0.79). CBA was faster (MD =  - 23.99; 95% CI: - 32.98 to - 15.00; p < 0.00001) with a higher risk of phrenic nerve palsy (RR = 6.88; 95% CI: 3.26 to 14.50, p < 0.00001). Acute PVI rate (RR = 1.0; 95% CI: 0.99 to 1.01, p = 0.95), overall complications (RR = 1.37; 95% CI: 0.93 to 2.01, p = 0.11), pericardial effusion (RR = 0.59; 95% CI: 0.25 to 1.41, p = 0.24), and fluoroscopy time (MD = 1.63; 95% CI: - 2.06 5.32; p = 0.39) did not significantly differ between the two procedures.

Conclusions: CBA and RFCA offer similar outcomes for patients with AF and PAF, with CBA being quicker but carrying a slightly higher risk of phrenic nerve palsy.