B-PO01-045 A PROSPECTIVE MULTICENTER U.S. COMPARISON OF RADIOFREQUENCY, CRYOBALLOON, AND LASER BALLOON MODALITIES FOR PULMONARY VEIN ISOLATION ABLATION IN PATIENTS WITH ATRIAL FIBRILLATION

Abstract

Pulmonary vein isolation (PVI) is a well-established treatment for pts with symptomatic atrial fibrillation (AF). In a prospective multicenter study, we examined procedural and long term outcomes of radiofrequency ablation (RF), cryoballoon ablation (CB), and laser balloon (LB) ablation in paroxysmal and persistent AF pts. National multicenter registry (4 U.S. centers). Consecutive pts undergoing first-time PVI were included. Follow-up, procedural data, and complications were prospectively recorded. Follow up: 3, 6, 12, 18, and 24 months. 14-day holter monitoring was based on symptoms. Primary outcomes were freedom from all atrial tachyarrhythmias (AAT), AF, or atrial flutter/tachycardia (AFT) lasting > 30 sec. 801 consecutive AF pts underwent RF (n=203), CB (n=324) and LB (n=274) PVI. Baseline characteristics and complications were similar for groups. At 24 months, single procedure success for RF was 61% for AAT, 67% for AF, 85% for AFT; CB was 68% for AAT, 73% for AF, 88% for AFT; LB was 77% for AAT, 82% for AF, 90% for AFT. As shown in Kaplan-Meier curves, LB PVI had higher freedom from AAT (p=0.004) and AF (p=0.026) than RF PVI. LB PVI had higher freedom from AFT (p=0.009) than the RF and CB PVI. Arrhythmia-free survival off antiarrhythmic drugs (AAD) was RF: 37% vs CB: 51% vs LB: 58% (p<0.001). First pass isolation of all PV was RF 63% vs CB 80% vs LB 78% (p<0.001). Procedure/LA dwell time was lower in CB group (p<0.001, p=0.025). Fluoroscopy time was lower in LB group (p<0.001). In this real-world prospective study of PVI modalities, LB PVI led to higher long term procedural success than RF PVI. LB PVI had higher freedom from AAT than both CB and RF PVI.