Pulmonary vein isolation in treatment of atrial fibrillation using radiofrequency or cryoballoon ablation: factors associated with better clinical outcomes

Background: Electrical pulmonary vein isolation (PVI) is still regarded as a cornerstone for treatment of paroxysmal and persistent atrial fibrillation (AF). It can be achieved by different techniques. We investigated the indications and techniques of PVI using radiofrequency ablation (RFA) and cryoballoon ablation (CBA) for AF and compared the efficacy of the two techniques for persistent AF. Methods and results: First, we conducted a prospective, randomized (1:1), open-label, multi-centre clinical trial to evaluate the effectiveness of PVI performed with CBA in comparison with contact force-sensing RFA in patients with persistent AF. A total of 101 patients (52 in CBA and 49 in RFA) were enrolled and followed up for 12 months. The CBA group showed a similar clinical outcome to RFA in terms of freedom from atrial tachyarrhythmia at 12 months (69.2% in CBA vs. 61.2% in RFA, P=0.393). In addition, CBA showed comparable complications (1 in CBA vs. 4 in RFA, P=0.353), less atrial flutter (AFL) recurrence (3.9% in RFA vs. 18.0% in CBA, P=0.020), and shorter procedure and ablation time (158.9±28.9 vs. 197.9±38.4 minutes, 35.8±6.5 vs. 55.9±16.7 minutes, respectively, both P