Audit on catheter ablation using the cryoballoon for persistent atrial fibrillation – Comparison with radiofrequency catheter ablation on procedural characteristics arrhythmia recurrence and symptom improvement in a UK tertiary centre

• Published in: European journal of arrhythmia & electrophysiology 2019-01, Vol.5, p.171
• Main Authors: Man, SH, Tawil, M, Ihekwaba, U K, Dsouza, R, Safwan, K, Stafford, P J, Sandilands, A J, Ng, G A, Lazdam, M, Somani, R
• Format: Article
• Language: English
• Subjects: Ablation; Cardiac arrhythmia; Catheters
• ISSN: 2058-3869; 2058-3877

Background: Pulmonary vein isolation (PVI) with radiofrequency (RF) catheter ablation is an established treatment for symptomatic persistent atrial fibrillation (AF). Data from the international CRYO4PERSISTENT AF trial had recently demonstrated 61% single-procedural success at 12 months in treating persistent AF with Cryoablation (Cryo) using the Achieve catheter with a Cryoballoon. We propose to conduct a local audit to study the efficacy of Cryo compared to RF ablation on procedure characteristics, arrhythmia recurrence and improvement of symptoms in patients undergoing persistent AF ablation. Method: Forty-eight consecutive patients who had undergone Cryo (n=29) or radiofrequency (RF) catheter ablation (n=19) for persistent AF from 1 January 2018 to 29 October 2018 were included in this study. Results: The median follow-up period was 11 months (Cryo: 10.9 ± 3.2 versus RF: 10.9 ± 2.2 months). The patients had comparable age (Cryo: 60.4 ± 11.3 versus RF: 57 ± 10.1 years old), gender distribution (Cryo: 20.7% versus RF: 15.8% female) and CHA2DS-VAS2c score (Cryo: 1.8 ± 1.2 versus RF: 1.3 ± 1.3). The left ventricular systolic function (LVSF) was also comparable between the two groups (normal LVSF: 51.7% Cryo versus 68.4% RF; mild to moderately impaired LVSF: 31% Cryo versus 26.3% RF; severely impaired LVSF: 10.3% Cryo versus 5.3% RF). Most patients underwent de novo ablation for persistent AF (Cryo 89.7% versus RF 68.4%, p=0.06). In the Cryoablation group, two main strategies were used, which were PVI only (n=14) or PVI and roofline (PVI+R) (n=13). In the RF group, five patients had PVI only and nine had PVI+R. Substrate ablation was used additionally to PVI with or without roofline ablation in some procedures in both groups (Cryo: n=2; RF: n=4). The total procedure time was significantly shorter with cryoablation compared to RF ablation of persistent AF (Cryo: 146 versus RF: 286 minutes; p