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Cryoballoon Ablation for the Treatment of Atrial Fibrillation: A Meta-analysis

[ Vol. 15 , Issue. 3 ]

Author(s):

Nirav Patel*, Krunalkumar Patel, Abhishek Shenoy, William L. Baker, Amgad N. Makaryus and Nabil El-Sherif   Pages 230 - 238 ( 9 )

Abstract:


Background: Ablation therapy is the treatment of choice in antiarrhythmic drugrefractory atrial fibrillation (AF). It is performed by either cryoballoon ablation (CBA) or radiofrequency ablation. CBA is gaining popularity due to simplicity with similar efficacy and complication rate compared with RFA. In this meta-analysis, we compare the recurrence rate of AF and the complications from CBA versus RFA for the treatment of AF.

Methods: We systematically searched PubMed for the articles that compared the outcome of interest. The primary outcome was to compare the recurrence rate of AF between CBA and RFA. We also included subgroup analysis with complications of pericardial effusion, phrenic nerve palsy and cerebral microemboli following ablation therapy.

Results: A total of 24 studies with 3527 patients met our predefined inclusion criteria. Recurrence of AF after CBA or RFA was similar in both groups (RR: 0.84; 95% CI: 0.65, 1.07; I2=48%, Cochrane p=0.16). In subgroup analysis, heterogeneity was less in paroxysmal AF (I2=0%, Cochrane p=0.46) compared to mixed AF (I2=72%, Cochrane p=0.003). Procedure and fluoroscopy time was less by 26.37 and 5.94 minutes respectively in CBA compared to RFA. Complications, pericardial effusion, and silent cerebral microemboli, were not different between the two groups, however, phrenic nerve palsy was exclusively present only in CBA group.

Conclusion: This study confirms that the effectiveness of CBA is similar to RFA in the treatment of AF with the added advantages of shorter procedure and fluoroscopy times.

Keywords:

Atrial fibrillation, cryoballoon ablation, meta-analysis, pericardial effusion, phrenic nerve palsy, radiofrequency ablation, silent cerebral microemboli.

Affiliation:

Division of Cardiology, Hartford Hospital, Hartford, CT, Division of Cardiology, North Shore University Hospital, Manhasset, NY, Division of Medicine, University of Virginia, Charlottesville, VA, Division of Cardiology, Hartford Hospital, Hartford, CT, Department of Cardiology, Nassau University Medical Center, East Meadow, NY, Division of Cardiology, Brooklyn VA Center, Brooklyn, NY

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