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Review: Single cryoballoon ablation procedure in patients with paroxysmal and persistent AF yields mixed results
Andrade J. Heart Rhythm. 2011;doi:10.1016/j.hrthm.2011.03.050.
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A single cryoballoon ablation procedure results in high acute and medium-term efficacy rates for paroxysmal atrial fibrillation and lower success rates when used as stand-alone therapy for persistent atrial fibrillation, according to a systematic review.
Researchers conducted a literature search using Medline, Embase and Biosis for abstracts specifically referencing cryoballoon for AF ablation. According to researchers, the search was limited to adults aged at least 19 years and publications dated between January 2000 and January 2011, but the language was not restricted to English. Overall, 23 articles were retained for final analysis: 20 reporting cryoballoon for paroxysmal AF, one reporting cryoballoon ablation for persistent AF, and two reporting cryoballoon ablation for both paroxysmal and persistent AF.
Results show that the ablation procedure was performed exclusively with cryoballoon in nine of 23 studies. Cryoballoon was combined with focal ablation in the remaining 14 studies in up to 17.1% of patients. Of 23 studies, 91.67% to 100% of patients and 94.87% to 100% of targeted veins had acute procedural success. Complete pulmonary vein isolation resulted in 77.81% of patients who underwent ablation with the cryoballoon catheter alone (95% CI, 74.99-80.45) and 92.64% of targets veins (95% CI, 91.76-93.45). In studies with cryoballoon ablation combined with concomitant focal cryoablation, 98.85% of patients (95% CI, 97.69-99.54) and 98.24% of targeted veins (95% CI, 97.69-98.68) achieved complete pulmonary vein isolation.
In 1-year freedom from recurrent AF off antiarrhythmic drug, there was a 73% 3-month blanking period and 60% no blanking period in patients with paroxysmal AF, whereas cryoballoon-based pulmonary vein isolation alone for persistent AF resulted in a 1-year freedom from AF of 45%, according to researchers. Researchers also found evidence that catheter ablation of persistent and permanent AF may require more extensive ablation beyond pulmonary vein isolation vs. paroxysmal AF. Treating paroxysmal AF with focal point-by-point radiofrequency ablation has shown success, but complications that included cardiac perforation with pericardial tamponade, injury to esophagus, phrenic nerve and aorta, and pulmonary vein stenosis were reported in 5% to 6% of patients.
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