Abstract
Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. Catheter ablation of atrial fibrillation plays an important role in the management of AF. Radiofrequency ablation is widely used in practice all over the world. Cryoablation has emerged as an alternative method for AF ablation. The FIRE and ICE trial was a non inferiority, multicentre, randomized trial that compared between the two modalities and proved cryoablation to be non inferior to radiofrequency in terms of efficacy and safety. However, the rate of AF recurrence was markedly high in both arms of the study.
Highlights
Atrial fibrillation (AF) is the most common arrhythmia worldwide and represents a significant burden on global healthcare[1]
The FIRE and ICE trial was a non inferiority, multicentre, randomized trial that compared between the two modalities and proved cryoablation to be non inferior to radiofrequency in terms of efficacy and safety
The fundamental concept of AF ablation is based on recognizing that electrical foci arising from the myocardial sleeves of pulmonary veins trigger and maintain AF2
Summary
Atrial fibrillation (AF) is the most common arrhythmia worldwide and represents a significant burden on global healthcare[1]. The FIRE and ICE study was a multicenter, randomized trial to compare the efficacy and safety of pulmonary vein isolation either by cryoablation or radiofrequency ablation. The primary efficacy end point occurred in 138 patients in the cryoballoon group and in 143 in the radiofrequency group (1-year Kaplan Meier event rate estimates, 34.6% and 35.9%, respectively; hazard ratio, 0.96; 95% confidence interval [CI], 0.76 to 1.22; P < 0.001 for noninferiority). There were no tracheosophageal fistulae in the RF group and only 10 phrenic nerve injuries in the cryo group, with only one persisting as a clinical problem after 2 years follow up[8] Even with such low rates, one must acknowledge that AF ablation carries a significantly higher risk of complications relative to other invasive electrophysiology procedures[7]. The study population may be more favourable than AF patients
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