A randomized comparison of cryoballoon versus duty-cycled multielectrode radiofrequency ablation for pulmonary vein isolation

Introduction: Cryoballoon (CB) and multipolar phased radiofrequency (RF) ablation with the Pulmonary Vein Ablation Catheter (PVAC) have been introduced as a faster and simpler procedure for pulmonary vein isolation (PVI). The available data suggest that each of these novel technologies offers similar efficacy but shorter procedure and fluoroscopy times than with point-by-point RF ablation. This study compared the acute and mid-term success and procedural parameters of CB and PVAC ablation in paroxysmal/persistent atrial fibrillation (AF).
Methods and Results: 60 consecutive patients undergoing PVAC (31 patients, age: 53±12.8y) or CB (29 patients, age: 55±12.2y) ablation for paroxysmal/persistent AF refractory to at least one antiarrhythmic drug (AAD) were enrolled. There was no difference in relevant baseline clinical parameters between the two groups. Significantly shorter procedure (104.9±38.6 vs. 135.8±31.4min), fluoroscopy(24±8.6 vs. 32±11.7min) and energy delivery (22.2±8.5 vs. 49.1±13.9 min) times were needed in the PVAC vs. the CB group, respectively. Similar success rates (97.1 % vs. 90.0%) were achieved in the isolation of the targeted pulmonary veins (PVs) and in the proportion of patients in whom of all PVs were isolated (90% vs. 79%) in both groups, but additional focal RF applications were required in 3 patients in the CB group. The atrial arrhythmia free survival at 6 months in patients off AAD was better after PVAC ablation (61.5% vs. 43.5%; p=0.02).
Conclusion: PV isolation with PVAC ablation is faster and results in a better success rate off AAD during a mid-term follow-up.