Outcomes of cryoballoon or radiofrequency ablation in symptomatic paroxysmal or persistent atrial fibrillation.
Aged
Atrial Fibrillation
/ physiopathology
Catheter Ablation
/ methods
Cohort Studies
Cryosurgery
/ methods
Female
Humans
Male
Middle Aged
Operative Time
Patient Readmission
Postoperative Complications
/ epidemiology
Proportional Hazards Models
Prospective Studies
Radiation Dosage
Recurrence
Reoperation
Treatment Outcome
Atrial fibrillation
Catheter ablation
Cryoballoon
Paroxysmal
Persistent
Radiofrequency
Journal
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
ISSN: 1532-2092
Titre abrégé: Europace
Pays: England
ID NLM: 100883649
Informations de publication
Date de publication:
01 Sep 2019
01 Sep 2019
Historique:
received:
29
01
2019
accepted:
03
05
2019
pubmed:
15
6
2019
medline:
15
12
2020
entrez:
15
6
2019
Statut:
ppublish
Résumé
To evaluate the effectiveness and safety of cryoballoon ablation (CBA) compared with radiofrequency ablation (RFA) for symptomatic paroxysmal or drug-refractory persistent atrial fibrillation (AF). Prospective cluster cohort study in experienced CBA and RFA centres. Primary endpoint was 'atrial arrhythmia recurrence', secondary endpoints were as follows: procedural results, safety, and clinical course. A total of 4189 patients were included: CBA 2329 (55.6%) and RFA 1860 (44.4%). Cryoballoon ablation population was younger, with fewer comorbidities. Procedure time was longer in the RFA group (P = 0.01). Radiation exposure was 2487 (CBA) and 1792 cGycm2 (RFA) (P < 0.001). Follow-up duration was 441 (CBA) and 511 days (RFA) (P < 0.0001). Primary endpoint occurred in 30.7% (CBA) and 39.4% patients (RFA) [adjusted hazard ratio (adjHR) 0.85, 95% confidence interval (CI) 0.70-1.04; P = 0.12). In paroxysmal AF, CBA resulted in a lower risk of recurrence (adjHR 0.80, 95% CI 0.64-0.99; P = 0.047). In persistent AF, the primary outcome was not different between groups. Major adverse cardiovascular and cerebrovascular event rates were 1.0% (CBA) and 2.8% (RFA) (adjHR 0.53, 95% CI 0.26-1.10; P = 0.088). Re-ablations (adjHR 0.46, 95% CI 0.34-0.61; P < 0.0001) and adverse events during follow-up (adjHR 0.64, 95% CI 0.48-0.88; P = 0.005) were less common after CBA. Higher rehospitalization rates with RFA were caused by re-ablations. The primary endpoint did not differ between CBA and RFA. Cryoballoon ablation was completed rapidly; the radiation exposure was greater. Rehospitalization due to re-ablations and adverse events during follow-up were observed significantly less frequently after CBA than after RFA. Subgroup analysis suggested a lower risk of recurrence after CBA in paroxysmal AF. ClinicalTrials.gov (NCT01360008), https://clinicaltrials.gov/ct2/show/NCT01360008.
Identifiants
pubmed: 31199860
pii: 5519195
doi: 10.1093/europace/euz155
pmc: PMC6735953
doi:
Banques de données
ClinicalTrials.gov
['NCT01360008']
Types de publication
Comparative Study
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1313-1324Investigateurs
J J Souza
(JJ)
A Stanley
(A)
S G Spitzer
(SG)
S Willems
(S)
T Dierk
(T)
R Borchard
(R)
K H Seidl
(KH)
R Zahn
(R)
G Groschup
(G)
I W P Obel
(IWP)
J H Gerds-Li
(JH)
R R Gopal
(RR)
J Schrickel
(J)
T Lewalter
(T)
A Stanley
(A)
W Moshage
(W)
L Eckardt
(L)
W Jung
(W)
P Kremer
(P)
A Lubinski
(A)
B Schumacher
(B)
L Lickfett
(L)
T Muenzel
(T)
C Steinwender
(C)
M Efremidis
(M)
T Deneke
(T)
D Q Nguyen
(DQ)
M Hochadel
(M)
S Schneider
(S)
Informations de copyright
© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.
Références
BMJ. 2000 Jan 1;320(7226):43-6
pubmed: 10617532
Lancet. 2002 Jan 26;359(9303):341-5
pubmed: 11830217
BMJ. 2004 Oct 30;329(7473):1039-42
pubmed: 15514356
Eur Heart J. 2013 Sep;34(35):2746-51
pubmed: 23900699
J Cardiovasc Electrophysiol. 2014 Aug;25(8):840-844
pubmed: 24654794
J Cardiovasc Electrophysiol. 2015 May;26(5):493-500
pubmed: 25644659
Europace. 2015 Jul;17(7):1030-7
pubmed: 25662987
N Engl J Med. 2015 May 7;372(19):1812-22
pubmed: 25946280
Europace. 2015 Aug;17(8):1229-35
pubmed: 26041872
Europace. 2016 Sep;18(9):1352-6
pubmed: 26838689
N Engl J Med. 2016 Jun 9;374(23):2235-45
pubmed: 27042964
Europace. 2017 Jan;19(1):48-57
pubmed: 27267554
Eur Heart J. 2016 Oct 07;37(38):2858-2865
pubmed: 27381589
Europace. 2016 Nov;18(11):1609-1678
pubmed: 27567465
Europace. 2017 Mar 1;19(3):378-384
pubmed: 27702864
J Am Heart Assoc. 2017 Jul 27;6(8):null
pubmed: 28751544
Europace. 2018 Jan 1;20(1):e1-e160
pubmed: 29016840
Int J Cardiol. 2018 May 15;259:82-87
pubmed: 29579616
JACC Clin Electrophysiol. 2017 Feb;3(2):154-161
pubmed: 29759388
Europace. 2019 Jan 1;21(1):91-98
pubmed: 29901719
Europace. 2018 Dec 1;20(12):1944-1951
pubmed: 29982554
Eur Heart J. 2018 Dec 1;39(45):4020-4029
pubmed: 30085086
Europace. 2019 Apr 1;21(4):581-589
pubmed: 30376055