Outcomes of cryoballoon or radiofrequency ablation in symptomatic paroxysmal or persistent atrial fibrillation

Ellen Hoffmann, Florian Straube*, Karl Wegscheider, Malte Kuniss, Dietrich Andresen, Li Qun Wu, Jürgen Tebbenjohanns, Georg Noelker, Roland Richard Tilz, Julian Kyoung Ryul Chun, Andreas Franke, Christoph Stellbrink, Arcadi Garcia-Alberola, Uwe Dorwarth, Andreas Metzner, Taoufik Ouarrak, Johannes Brachmann, Karl Heinz Kuck, Jochen Senges, J. J. SouzaA. Stanley, S. G. Spitzer, S. Willems, T. Dierk, R. Borchard, K. H. Seidl, R. Zahn, G. Groschup, I. W.P. Obel, J. H. Gerds-Li, R. R. Gopal, J. Schrickel, T. Lewalter, A. Stanley, W. Moshage, L. Eckardt, W. Jung, P. Kremer, A. Lubinski, B. Schumacher, L. Lickfett, T. Muenzel, C. Steinwender, M. Efremidis, T. Deneke, D. Q. Nguyen, M. Hochadel, S. Schneider

*Corresponding author for this work
17 Citations (Scopus)


Aims: To evaluate the effectiveness and safety of cryoballoon ablation (CBA) compared with radiofrequency ablation (RFA) for symptomatic paroxysmal or drug-refractory persistent atrial fibrillation (AF). Methods and results: Prospective cluster cohort study in experienced CBA and RFA centres. Primary endpoint was 'atrial arrhythmia recurrence', secondary endpoints were as follows: procedural results, safety, and clinical course. A total of 4189 patients were included: CBA 2329 (55.6%) and RFA 1860 (44.4%). Cryoballoon ablation population was younger, with fewer comorbidities. Procedure time was longer in the RFA group (P = 0.01). Radiation exposure was 2487 (CBA) and 1792 cGycm2 (RFA) (P < 0.001). Follow-up duration was 441 (CBA) and 511 days (RFA) (P < 0.0001). Primary endpoint occurred in 30.7% (CBA) and 39.4% patients (RFA) [adjusted hazard ratio (adjHR) 0.85, 95% confidence interval (CI) 0.70-1.04; P = 0.12). In paroxysmal AF, CBA resulted in a lower risk of recurrence (adjHR 0.80, 95% CI 0.64-0.99; P = 0.047). In persistent AF, the primary outcome was not different between groups. Major adverse cardiovascular and cerebrovascular event rates were 1.0% (CBA) and 2.8% (RFA) (adjHR 0.53, 95% CI 0.26-1.10; P = 0.088). Re-ablations (adjHR 0.46, 95% CI 0.34-0.61; P < 0.0001) and adverse events during follow-up (adjHR 0.64, 95% CI 0.48-0.88; P = 0.005) were less common after CBA. Higher rehospitalization rates with RFA were caused by re-ablations. Conclusions: The primary endpoint did not differ between CBA and RFA. Cryoballoon ablation was completed rapidly; the radiation exposure was greater. Rehospitalization due to re-ablations and adverse events during follow-up were observed significantly less frequently after CBA than after RFA. Subgroup analysis suggested a lower risk of recurrence after CBA in paroxysmal AF. Trial Registration: ClinicalTrials.gov (NCT01360008), https://clinicaltrials.gov/ct2/show/NCT01360008.

Original languageEnglish
Issue number9
Pages (from-to)1313-1324
Number of pages12
Publication statusPublished - 01.09.2019


Dive into the research topics of 'Outcomes of cryoballoon or radiofrequency ablation in symptomatic paroxysmal or persistent atrial fibrillation'. Together they form a unique fingerprint.

Cite this