For patients with AF, HFrEF, cryoballoon noninferior to radiofrequency ablation
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Key takeaways:
- Cryoballoon ablation was noninferior to radiofrequency ablation in patients with atrial fibrillation and HFrEF.
- Cryoballoon ablation was linked with shorter procedure times in this population.
In patients with atrial fibrillation and heart failure with reduced ejection fraction, cryoballoon ablation was noninferior to radiofrequency ablation, according to the results of the CRABL-HF trial.
However, cryoballoon ablation was associated with shorter procedure times in this population, researchers reported at the European Society of Cardiology Congress.
Kengo Kusano, MD, chief director of the department of cardiovascular medicine and the director of the division of arrhythmia and electrophysiology at National Cerebral and Cardiovascular Center, Suita, Japan, said in a press conference that a rhythm control strategy for patients with AF and HFrEF has been associated with increased left ventricular EF and decreased risk for all-cause mortality and HF hospitalization, but “the majority of these studies were conducted using radiofrequency ablation, and there remains a lack of evidence regarding the efficacy of other ablation energies, such as cryoballoon ablation, in AF patients with HFrEF.”
Kusano and colleagues randomly assigned 110 patients with AF requiring catheter ablation and HF with EF 40% or less to receive cryoballoon ablation (n = 55; mean age, 68 years; 16% women) or radiofrequency ablation (n = 55; mean age, 65 years; 26% women).
The primary outcome was atrial tachyarrhythmias at 1 year after a 90-day blanking period, determined by ECGs recorded twice daily (HCG801, Omron).
Total procedure time was 101 minutes in the cryoballoon group compared with 165 minutes in the radiofrequency group (P < .001), Kusano said at the press conference. He also said the cryoballoon group had lesser fluid balance (–24 mL vs. 685 mL; P < .001).
After the procedure, left atrial peak and left atrial pulse pressure were lower in the cryoballoon group than in the radiofrequency group (P < .001 for both), and there were no cases of procedure-related death or worsening HF in either group, he said.
There were no differences between the groups in the primary endpoint (cryoballoon, 22.2%; radiofrequency, 21.8%; HR = 1.02; 95% CI, 0.46-2.28; P = .96; P for noninferiority = .033), and the results were consistent across prespecified subgroups, according to the researchers.
There was also no difference between the groups at 1 year in all-cause death or HF hospitalization (HR = 0.79; 95% CI, 0.21-2.94; P = .72).
LVEF and LA volume index improved at 1 year in both groups, as did quality of life as assessed by the Atrial Fibrillation Effect of Quality-of-life score, Kusano and colleagues found.
Cryoballoon ablation was noninferior to radiofrequency ablation “with a comparable efficacy for the LV and LA function,” Kusano said at the press conference. “In addition, [cryoballoon] ablation could be performed with a shorter procedure time and lesser fluid balance without increasing the LA pressure during catheter ablation.”
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Kusano K, et al. Hot line 10. Presented at: European Society of Cardiology Congress; Aug. 30-Sept. 2, 2024; London (hybrid meeting).
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