First-line catheter ablation of paroxysmal atrial fibrillation: Outcome of radiofrequency vs. cryoballoon pulmonary vein isolation

Florian Straube*, Uwe Dorwarth, Sonia Ammar-Busch, Timo Peter, Georg Noelker, Thomas Massa, Malte Kuniss, Niels Christian Ewertsen, Kyoung Ryul Julian Chun, Juergen Tebbenjohanns, Roland Tilz, Karl Heinz Kuck, Taoufik Ouarrak, Jochen Senges, Ellen Hoffmann

*Corresponding author for this work
64 Citations (Scopus)


Aims First-line ablation prior to antiarrhythmic drug (AAD) therapy is an option for symptomatic paroxysmal atrial fibrillation (PAF); however, the optimal ablation technique, radiofrequency (RF), or cryoballoon (CB) has to be determined. Methods and results The FREEZE Cohort Study compares RF and CB ablation. Treatment-naïve patients were documented in the FREEZEplus Registry. Periprocedural data and outcome were analysed. From 2011 to 2014, a total of 373/4184 (8.9%) patients with PAF naïve to AAD were identified. Pulmonary vein isolation (PVI) was performed with RF (n = 180) or CB (n = 193). In the RF group, patients were older (65 vs. 61 years, P < 0.01) compared with the CB group. The procedure time was significantly shorter and radiation exposure higher in the CB group. Major adverse events occurred in 1.6% (CB) and 3.7% (RF) of patients (P = 0.22). AF/atrial tachycardia (AT) recurrence until discharge was 4.5% (RF) and 8.5% (CB, P = 0.2). Follow-up (FU) ≥12 months was available in 99 (RF) and 107 (CB) patients. After 1.4 years of FU, freedom from AF/atrial tachycardia (AT) was 61% (RF) and 71% (CB, P = 0.11). In the RF group, more patients underwent cardioversion, and a trend for more repeat ablations was observed. Persistent phrenic nerve palsy was observed in one patient treated by CB. Conclusion First-line ablation for PAF is safe and effective with either RF or CB. The procedure was faster with the CB, but the radiation exposure was higher. Although there was a trend for more recurrences and complications in the RF group, a more favourable risk profile in patients undergoing CB ablation might have biased the results. Published on behalf of the European Society of Cardiology. All rights reserved.

Original languageEnglish
Issue number3
Pages (from-to)368-375
Number of pages8
Publication statusPublished - 01.03.2016

Research Areas and Centers

  • Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

  • 205-12 Cardiology, Angiology

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