Safety and Efficacy of Different Catheter Ablations for Atrial Fibrillation: A Systematic Review and Meta-Analysis.

Abstract

Previous studies suggested that cryoballoon ablation had clinical benefits comparable to those of radiofrequency ablation. However, recently, some new catheters have been invented, and no universal consensus exists on which ablation is the optimal choice. The present systematic review and meta-analysis aimed to assess and compare the safety and efficacy of cryoballoon and radiofrequency ablation by synthesizing published trials. A systematic literature review was conducted searching Medline, PubMed, Embase, Cochrane Library, and so forth. All trials comparing cryoballoon and radiofrequency ablation were screened and included if inclusion criteria were met. A total of 40 eligible studies were identified, adding up to 11,395 patients. The follow-up period ranged from 3 months to 25 months. Overall analyses indicated that cryoballoon ablation could bring more benefit in procedural time (risk ratio [RR] = -0.39, 95% confidence interval [CI]: -0.62 to -0.15), atrial fibrillation (AF) recrudescence (RR = 0.82, 95% CI: 0.70-0.96), and major complications (RR = 0.74, 95% CI: 0.58-0.95) for patients with AF. For the subgroups, the first-generation cryoballoon significantly reduced procedural time and major complications, but it increased ablation time. The patients referred for the second-generation cryoballoon (CBA) seemed to receive more clinical benefit (procedural time, fluoroscopic time, ablation time, AF recrudescence) and fewer complications. Finally, multiparty catheter (MTCA) was found to significantly reduce procedural and fluoroscopic times with a high rate of AF recrudescence. The present systematic review and meta-analysis demonstrated that cryoballoon ablation was associated with greater freedom from AF, shorter procedural time, and lower rate of major complications, compared with radiofrequency ablation. Especially, CBA was more advantageous. However, MTCA seems promising for radiofrequency ablation.