Abstract 12759: Catheter Ablation of Atrial Fibrillation: A Network Meta-Analysis of Radiofrequency and Balloon-Based Technologies

• Published in: Circulation (New York, N.Y.) N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A12759-A12759
• Main Authors: Kheiri, Babikir, Osman, Mohammed, Dalouk, Khidir, Stecker, Eric
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.140.suppl_1.12759

IntroductionPulmonary vein isolation (PVI) is the most reliable method for restoring sinus rhythm in patients with atrial fibrillation (AF). Although many ablation technologies have been developed and tested, comparisons of procedural success and complications between technologies are lacking.HypothesisLong-term success varies based on the ablation technology utilized.MethodsElectronic database searches were performed for all randomized trials that compared various radiofrequency (RF) and balloon-based technologies (point-by-point RF [pbpRF], pbpRF with contact force-sensing catheter [pbpRF+CF], duty-cycled RF [dcRF], cooled dcRF [GOLD], HotBalloon RF [HB], circular thermocool catheter [nMARQ], cryoballoon [CB], laser-balloon (VGLB), Mesh Ablator [HDMA]) in patients with AF without heart failure. Bayesian network meta-analysis was performed.ResultsA total of 49 trials randomizing 8,815 patients (age 60.9±10.2, 32.7% female) were included. In patients with paroxysmal AF, compared with antiarrhythmic drugs (AAD), there was significantly higher freedom from AF with pbpRF, pbpRF+CF, dcRF, CB, VGLB, and HB (hazard ratios [HR] range from 2.38 to 7.11) but not with GOLD or HDMA. In patients with persistent AF, there were no significant differences among the competing interventions compared with AAD. Compared with pbpRF, acute PVI were significantly lower with dcRF, nMARQ, and HDMA; redo procedures were significantly lower with pbpRF+CF and VGLB and significantly higher with dcRF; procedural times were significantly lower with dcRF and CB. No significant differences were observed with regard to quality-of-life between ablation technologies. Overall, complications rates were infrequent; radiofrequency was observed to have higher pulmonary vein stenosis and cardiac tamponade, however, balloon-based technologies had higher phrenic palsies.ConclusionsThere were significant differences in procedural success between ablation technologies. For paroxysmal AF, pbpRF, pbpRF+CF, dcRF, CB, VGLB, and HB achieved higher rates of sinus rhythm compared to AAD, and GOLD and HDMA had no benefit. For persistent AF, there were no significant differences observed among ablation technologies.