Procedure characteristics and outcomes of atrial fibrillation ablation procedures using cryoballoon versus radiofrequency ablation: A report from the GWTG-AFIB registry

Daniel J. Friedman*, Da Juanicia Holmes, Anne B. Curtis, Kenneth A. Ellenbogen, David S. Frankel, Bradley P. Knight, Andrea M. Russo, Roland Matsouaka, Mintu P. Turakhia, William R. Lewis, Jonathan P. Piccini

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Cryoballoon ablation (CBA) is an alternative to radiofrequency ablation (RFA) for ablation of atrial fibrillation (AF) and real-world comparisons of this strategy are lacking. As such, we sought to compare patient and periprocedural characteristics and outcomes of CBA versus RFA in the Get With the Guidelines AFIB Registry. Methods: Categorical variables were compared via the χ2 test and continuous variables were compared via the Wilcoxon rank-sum test. Adjusted analyses were performed using overlap weighting of propensity scores. Results: A total of 5247 (1465 CBA, 3782 RFA) ablation procedures were reported from 33 sites. Those undergoing CBA more often had paroxysmal AF (60.0% vs. 48.8%) and no prior AF ablation (87.5% vs. 73.8%). CHA2DS2-VASc scores were similar. Among de novo ablations, most ablations involved intracardiac echocardiography and electroanatomic mapping, but both were less common with CBA (87.3% vs. 93.9%, p <.0001, and 87.7% vs. 94.6%, p <.0001, respectively). CBA was associated with shorter procedures (129 vs. 179 min, p <.0001), increased fluoroscopy use (19 vs. 11 min, p <.0001), and similar ablation times (27 vs. 35 min, p =.15). Nonpulmonary vein ablation was common with CBA: roof line 38.6%, floor line 20.4%, cavotricuspid isthmus 27.7%. RFA was associated with more total complications compared to CBA (5.4% vs. 2.3%, p <.0001), due to more volume overload and “other” events, although phrenic nerve injury was more common with CBA (0.9% vs 0.1%, p =.0001). In the adjusted model, any complication was less common among CBA cases (odds ratio, 0.45; confidence interval, 0.25–0.79, p =.0056). Conclusion: CBA was associated with fewer complications, and shorter procedure times, and greater fluoroscopy times, compared to RFA. Nonpulmonary vein ablation and electroanatomic mapping system use was common with CBA.

Original languageEnglish (US)
JournalJournal of cardiovascular electrophysiology
DOIs
StateAccepted/In press - 2020

Keywords

  • ablation
  • atrial fibrillation
  • complications
  • cryoablation
  • radiofrequency

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Fingerprint Dive into the research topics of 'Procedure characteristics and outcomes of atrial fibrillation ablation procedures using cryoballoon versus radiofrequency ablation: A report from the GWTG-AFIB registry'. Together they form a unique fingerprint.

Cite this