Comparison of Ablation Technologies of Paroxysmal Atrial Fibrillation. Our 1 Year Follow-Up Experience

Background: Cryoballoon pulmonary vein isolation (PVI) has been developed as a alternative technology for ablation of atrial fibrillation (AF). Our objective is to compare Cryo-PVI and PVI using radiofrequency energy (RF-PVI) results during 1 year follow-up.

Methods: Cryo-PVI was performed in 35 patients using a 28-mm cryoballoon ablation catheter (Arctic Front, MDT). 35 patients undergoing RF-PVI using irrigated RF ablation catheter and navigation mapping system (Carto 3, BW) served as a control group. The procedural endpoint was PVI confirmed by a circumferential mapping catheter. Follow-up was performed 3,6 and 12 month after the procedure.

Results: This study included 70 patients with paroxysmal atrial fibrillation (age 56±13 years, left atrial size 40±4 mm). After single procedure and during 1 year follow-up 23 patients (66%) were free from AF without antiarrhythmic drugs (AAD) in the Cryo-PVI group. In the RF-PVI group 25 patients (71%) had sinus rhythm without AAD. Significantly differences were procedure and fluoroscopy duration – 112±27 and 19,5±5,7 in the Cryo-PVI group versus 154±42 and 32±9,3 in the RF-PVI group (p<0,001). When including repeat procedures with a mean of 1,5±0,5 procedures per patient, 30 of 35 patients (85%) in the Cryo-PVI group and 29 of 35 patients (83%) in the RF-PVI group (1,4±0,6 procedures per patient) remained in stable sinus rhythm without AAD.

Conclusion: Single procedure efficacy of PVI is approximately 60% during 1 year follow-up and this is independent of the energy source used, but significantly difference of approaches were procedure and fluoroscopy durations (p<0,001). When including repeat procedures in 36% of patients, outcomes is increased to approximately 83%.