Comparative analysis of cryoballoon versus radiofrequency catheter ablation in atrial fibrillation patients with impaired left ventricular ejection fraction

Abstract

BACKGROUND: In selected patients with atrial fibrillation (AF) and impaired left ventricular ejection fraction (LVEF), catheter ablation has been proposed for rhythm control. It is unclear, if cryoballoon (CBA) or radiofrequency (RFA) ablation is the preferred technique. METHODS: The FREEZE Cohort (NCT01360008) sub-analysis included patients with LVEF < 50 % undergoing CBA (Group A) or RFA (Group B) comparing baseline characteristics, procedural data and outcome. RESULTS: From 2011 to 2016; 4,189 patients were enrolled, with 256 (6.1 %) qualifying for the sub-analysis and divided into two groups: 118 (Group A) and 138 (Group B). Mean age was 63.4 ± 9.9 years (p = 0.07), with 60.9 % suffering from persistent AF (p = 0.46). Mean LVEF was 42.0 % (p = 0.81). CHA(2)DS(2)-VASc Score was lower in Group A (p < 0.01). Group A had shorter procedure and left atrial times (p < 0.001) but higher fluoroscopy times (p < 0.001) and dose area products (p < 0.01). Acute PVI was achieved in 96.4 % (p = 0.57). Complications were lower in Group A (5.1 % vs. 13.1 %, p < 0.05). After 449 and 516 days (p < 0.001), no differences in arrhythmia recurrence were observed (51.2 % vs. 58.7 %, p = 0.30), but rehospitalizations were more frequent in Group B (34.9 % vs. 52.1 %, p < 0.05). A trend for more re-ablations was observed in Group B (11.5 vs. 22.1 %, p = 0.06). Female sex was the sole independent predictor of arrhythmia recurrence. CONCLUSION: CBA procedures were associated with lower rates of complications, fewer rehospitalizations, and shorter procedural times, whereas RFA procedures resulted in lower radiation exposure. Overall, AF ablation in patients with impaired LVEF is an effective initial ablation strategy with either RFA or CBA.