Efficacy comparison between cryoablation and radiofrequency ablation for patients with cavotricuspid valve isthmus dependent atrial flutter: a meta-analysis.

Yi-He Chen,Cheng-Long Xie,Hui Lin,Xiao-Ting Zhang,Yi-Gang Li

doi:10.1038/srep10910

Yi-He Chen, Cheng-Long Xie + Show 3 more

Open Access

https://doi.org/10.1038/srep10910

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Journal: Scientific Reports	Publication Date: Jun 3, 2015
Citations: 9	License type: CC BY 4.0

Affiliation: XinHua Hospital, Wenzhou Medical University

Abstract

We perform this meta-analysis to compare the efficacy and safety of cryoablation versus radiofrequency ablation for patients with cavotricuspid valve isthmus dependent atrial flutter. By searching EMBASE, MEDLINE, PubMed and Cochrane electronic databases from March 1986 to September 2014, 7 randomized clinical trials were included. Acute (risk ratio[RR]: 0.93; P = 0.14) and long-term (RR: 0.94; P = 0.08) success rate were slightly lower in cryoablation group than in radiofrequency ablation group, but the difference was not statistically significant. Additionally, the fluoroscopy time was nonsignificantly reduced (weighted mean difference[WMD]: −2.83; P = 0.29), whereas procedure time was significantly longer (WMD: 25.95; P = 0.01) in cryoablation group compared with radiofrequency ablation group. Furthermore, Pain perception during the catheter ablation was substantially less in cryoabaltion group than in radiofrequency ablation group (standardized mean difference[SMD]: −2.36; P < 0.00001). Thus, our meta-analysis demonstrated that cryoablation and radiofrequency ablation produce comparable acute and long-term success rate for patients with cavotricuspid valve isthmus dependent atrial flutter. Meanwhile, cryoablation ablation tends to reduce the fluoroscopy time and significantly reduce pain perception in cost of significantly prolonged procedure time.

Highlights

Treatment for atrial flutter, and the acute success rate is high and the recurrence rate during the follow-up is low when bidirectional conduction block (BCB) is achieved[4]
7 studies, which enrolled 496 patients (83.5% male, mean age 63.1 years, mean follow-up 10.0 months), 247 patients referred for cryoablation and 247 patients referred for radiofrequency ablation procedure, were included in this meta-analysis (Fig. 1)
History of atrial fibrillation referred for each treatment (43.4% for cryoablation and 41.2% for radiofrequency ablation) was similar between two groups

Summary

Introduction

Treatment for atrial flutter, and the acute success rate is high and the recurrence rate during the follow-up is low when bidirectional conduction block (BCB) is achieved[4]. Cryoablation, an alternative energy source, has been reported to have similar acute and long term efficacy and safety rates as radiofrequency ablation for patients with atrial arrhythmias from randomized or nonrandomized clinical studies[7]. It may overcome some disadvantages of radiofrequency ablation, especially the severe chest discomfort, and longer fluoroscopy time than cryoablation[8]. There was already meta-analysis comparing cryoablation with radiofrequency ablation in patients with atrial flutter[9], recently, newly published randomized controlled trails (RCTs) provided more valuable information on this issue. In this meta-analysis, we included 7 RCTs comparing the efficacy and safety between cryoablation and radiofrequency ablation in patients with atrial flutter, in an effort to supply updated information on this issue

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Conclusion