Comparative Efficacy and Safety of Cryoballoon vs Laser Balloon Ablation for Pulmonary Vein Isolation in Patients With Paroxysmal Atrial Fibrillation.

Abstract

Purpose: Atrial fibrillation (AF), the most common arrhythmia in older adults, is often treated with cryoballoon ablation (CBA) or laser balloon ablation (LBA) when refractory to medication. We used real-world patient data to investigate differences in arrhythmia-free survival, procedure and fluoroscopy times, and complications between these techniques.

Methods: In this single-center, retrospective study of 178 patients with symptomatic paroxysmal AF referred for first-time pulmonary vein isolation (PVI), 103 underwent CBA, and 75 underwent LBA. Recurrence was defined as any atrial arrhythmia of >30 seconds' duration after a three-month blanking period. Complications at 30 days were recorded. Kaplan-Meier analysis was used to estimate arrhythmia-free survival at one year for both groups. Categorical variables were expressed as n (%) and continuous variables as mean±standard deviation or median (Q1, Q3).

Results: Baseline characteristics were similar between groups, with exception to left atrial volume index (CBA 32.2±10.9 ml/m²; LBA 36.0±11.0 ml/m², p=0.047). History of stroke was higher in CBA (13.6% vs 2.7%; p=0.012), as was coronary artery disease (35.0% vs 14.7%, p=0.002). Median fluoroscopy and procedure times (min) were significantly shorter in LBA (24.2 vs 31.6, p=0.004; 141.0 vs 210.0, p<0.0001, respectively). One-year arrhythmia-free survival rates were similar (CBA 79.1% vs LBA 78.7%, p=0.934), as were total complication rates (21.4% vs 16.0%, p=0.289), including rates of transient ischemic attack/stroke and vascular complications.

Conclusions: In patients with paroxysmal AF undergoing PVI, CBA and LBA were equally efficacious at one year and demonstrated acceptably low complication rates. LBA was associated with reduced procedure time and fluoroscopy exposure.