Clinical Medicine II.
Krisztian Kassa1,2, Zsofia Nagy2, Zoltan Som2, Csaba Foldesi2, Attila Kardos2
1 Semmelweis University, Budapest, Hungary
2 Gottsegen National Cardiovascular Center, Budapest, Hungary
Introduction: To date, point-by-point radiofrequency and cryoballoon ablation are the most commonly used techniques for pulmonary vein isolation (PVI).
Aims: This study aimed to compare the efficacy and safety of ablation-index (AI) guided high-power radiofrequency (HRF) and second-generation cryoballoon (CB2) ablation in patients with atrial fibrillation (AF).
Method: Symptomatic patients (61% male, mean age: 62±10 years, CHA2DS2-VASc score: 2.1±1.5) with paroxysmal (62%) or persistent (38%) AF underwent PVI by HRF (n=103) or CB2 (n=273). In the HRF group, 50W power was used, aiming AI values 550 at the anterior and 400 at the posterior wall (power-controlled mode, target inter-lesion distance <6 mm). For cryoablation, a strategy of 180/240 second freeze time was used on the right/left sided pulmonary veins.
Results: The recurrence rate did not differ significantly between the groups after 12 months (HRF: 22% vs. CB2: 28%, p=0.089). Major complication rate was below 1% using each ablation strategy. Procedural time was significantly shorter in the CB2 group (92±30 min vs. 51.3±14.7 min, p<0.001), while both fluoroscopy time (5.7±4.6 min vs. 10.0±4.9 min, p<0.001) and fluoroscopy dose (401±514 cGycm2 vs. 1857±1898 cGycm2, p<0.001) were significantly higher using cryoballoon ablation.
Conclusion: AI guided HRF and CB2 ablation are comparable regarding clinical efficacy and safety. HRF PVI procedures take longer time, however radiation exposure is markedly reduced compared to CB2 ablation.
Funding: The authors received no financial support for the research, authorship, and/or publication of this study.