Cryoballoon Ablation as Effective as Radiofrequency for Persistent AF, suggests study

A new study published in the European Heart Journal showed that in individuals with persistent atrial fibrillation (AF), cryoballoon ablation (CB) did not perform worse than radiofrequency (RF) ablation in terms of the incidence of atrial tachyarrhythmias after one year.

With extensive clinical use, catheter ablation has become a recognized treatment technique for atrial fibrillation. Three main techniques are used to regulate arrhythmias, which being autonomic nervous system modulation, electrophysiological substrate alteration, and removal of AF triggers. The mainstay of catheter ablation for both paroxysmal and chronic AF is pulmonary vein isolation (PVI).

In addition to conventional radiofrequency (RF) ablation therapy, cryoballoon ablation, a more modern approach, has been popular in recent years for treating AF, particularly paroxysmal AF. The 2024 ESC Guidelines include a Class IIa recommendation for endoscopic and hybrid ablation procedures in symptomatic persistent AF that is resistant to antiarrhythmic drug (AAD) treatment, as well as a Class I recommendation for PVI in paroxysmal AF.

The effectiveness, safety, and effect on reverse remodelling of cryoballoon ablation vs radiofrequency ablation for persistent atrial fibrillation are not well-documented. Thus, this study evaluated the effectiveness of cryoballon ablation.

A total of 12 centers randomly assigned 500 patients with persistent atrial fibrillation. The incidence of atrial tachyarrhythmias one year following ablation, with a 90-day blanking interval, was the main outcome. With a median age of 69 years (interquartile range: 61–74), the final analysis comprised 499 patients, of whom 249 were assigned to the cryoballoon group and 250 to the radiofrequency group.

A total of 56 patients (22.5%) in the cryoballoon group and 58 (23.2%) in the radiofrequency group experienced the primary endpoint in the intention-to-treat analysis; the cryoballoon group did not show inferiority to the radiofrequency group for the primary endpoint (hazard ratio.99; 95% CI,.69–1.43; P =.96).

The left atrial size (left atrial volume index) decreased more in the radiofrequency group than in the cryoballoon group at one year [−11 mL/m2 (interquartile range: -19 to -4), vs. −4 mL/m2 (interquartile range: 13 to 3), P <.001]. Overall, cryoballoon ablation was shown to be noninferior to radiofrequency ablation in avoiding atrial tachyarrhythmias over a one-year period in a randomized experiment that included 500 patients with persistent atrial fibrillation.

Reference:

Miyamoto, K., Kanaoka, K., Yodogawa, K., Fujimoto, Y., Fukunaga, H., Asano, S., Nagase, T., Terasawa, M., Kusume, T., Takada, Y., Takarada, K., Sagawa, Y., Shigeta, T., Ooka, J., Ishikura, M., Yoh, M., Takahashi, H., Inoue, Y., Nagase, S., … Kusano, K. (2025). Cryoballoon vs radiofrequency ablation in persistent atrial fibrillation: the CRRF-PeAF trial. European Heart Journal. https://doi.org/10.1093/eurheartj/ehaf451