Cryoballoon Versus Radiofrequency Ablation for Persistent Atrial Fibrillation: Meta‐Analysis of Randomized Trials
6 affiliations
- 1Faculty of Medicine Imperial College London, England London UK
- 2London Northwest Healthcare NHS Trust, England London UK
- 3Department of Internal Medicine University of Pennsylvania Philadelphia Pennsylvania USA
- 4Chelsea and Westminster Hospital NHS Foundation Trust, England London UK
- 5National Heart and Lung Institute Imperial College London, England London UK
- 6Department of Cardiology Imperial College Healthcare NHS Trust, England London UK
Abstract
Introduction: Pulmonary vein isolation (PVI) alone achieves modest arrhythmia freedom in persistent atrial fibrillation (PeAF). Cryoballoon ablation (CBA) offers a single‐shot alternative to radiofrequency ablation (RFA) that streamlines procedural workflow. We aimed to quantify the clinical efficacy, procedural efficiency, and safety of CBA versus RFA through a meta‐analysis of randomized controlled trials (RCTs).
Methods and Results: Systematic review of PubMed, Embase, and Scopus identified 5 RCTs enrolling 1,091 patients (515 CBA, 576 RFA). The primary endpoint was 12‐month freedom from any atrial arrhythmia, with isolated AF, and atrial tachycardia/flutter evaluated as secondary endpoints. Random‐effects models generated relative risks (RRs) and mean differences (MDs) with 95% confidence intervals (CI). Time‐to‐event data were pooled using a generic inverse‐variance approach to derive hazard ratios (HR). CBA and RFA demonstrated equivalent freedom from any arrhythmia (RR 0.97, 95% CI 0.81–1.15; p = 0.71). Time‐to‐event analysis corroborated a comparable recurrence hazard (HR 0.91, 95% CI 0.67–1.24; p = 0.56; I 2 = 0%). Repeat ablation rates were identical (RR 0.93; p = 0.50). CBA significantly reduced procedural time (MD −45.37 min; p < 0.0001), while major complications were comparable (1.5% vs. 2.7%; p = 0.18). Trial sequential analysis indicated that further randomization is unlikely to demonstrate superiority.
Conclusion: In PeAF, CBA and RFA achieve equivalent 12‐month arrhythmia‐free survival and comparable repeat‐ablation rates, while CBA confers a highly significant reduction in procedural time. However, reliance on 12‐month follow‐up and heterogeneous rhythm surveillance protocols may limit assessments of true long‐term durability.
Related
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- Predictive Value of Left Atrial Strain Combined with Low-Voltage Substrate for Recurrence After Radiofrequency Catheter Ablation in Persistent Atrial Fibrillation
- Tailor‐Made Hybrid Pulsed‐Field and Radiofrequency Ablation Guided by ExTRa Mapping for Refractory Long‐Standing Persistent Atrial Fibrillation: First Experience With the Affera System Prism‐2
- Comparative efficacy of esophageal protection strategies during radiofrequency atrial fibrillation ablation: a systematic review and network meta-analysis of randomized trials.
- Repeat Ablation for Persistent Atrial Fibrillation: CFA/DOA-Guided Substrate Ablation Versus Re-PVI Alone in the Prematurely Terminated Randomized AF-CAM Trial
BibTeX
@article{bola2026cryoballoon,
title = {{Cryoballoon Versus Radiofrequency Ablation for Persistent Atrial Fibrillation: Meta‐Analysis of Randomized Trials}},
author = {Harroop Bola and Aksaan Arif and Joshua J. Hon and Gayathri Giritharan and Prachur Khandelwal and Rodrick Avakian and Amar Rai and Kiran Haresh Kumar Patel and Fu Siong Ng},
journal = {Pacing and Clinical Electrophysiology},
year = {2026},
month = jul,
doi = {10.1111/pace.70350},
url = {https://doi.org/10.1111/pace.70350},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Cryoballoon Versus Radiofrequency Ablation for Persistent Atrial Fibrillation: Meta‐Analysis of Randomized Trials
AU - Harroop Bola
AU - Aksaan Arif
AU - Joshua J. Hon
AU - Gayathri Giritharan
AU - Prachur Khandelwal
AU - Rodrick Avakian
AU - Amar Rai
AU - Kiran Haresh Kumar Patel
AU - Fu Siong Ng
PY - 2026
DA - 2026/07/03
JO - Pacing and Clinical Electrophysiology
DO - 10.1111/pace.70350
UR - https://doi.org/10.1111/pace.70350
AB - Introduction: Pulmonary vein isolation (PVI) alone achieves modest arrhythmia freedom in persistent atrial fibrillation (PeAF). Cryoballoon ablation (CBA) offers a single‐shot alternative to radiofrequency ablation (RFA) that streamlines procedural workflow. We aimed to quantify the clinical efficacy, procedural efficiency, and safety of CBA versus RFA through a meta‐analysis of randomized controlled trials (RCTs). Methods and Results: Systematic review of PubMed, Embase, and Scopus identified 5 RCTs enrolling 1,091 patients (515 CBA, 576 RFA). The primary endpoint was 12‐month freedom from any atrial arrhythmia, with isolated AF, and atrial tachycardia/flutter evaluated as secondary endpoints. Random‐effects models generated relative risks (RRs) and mean differences (MDs) with 95% confidence intervals (CI). Time‐to‐event data were pooled using a generic inverse‐variance approach to derive hazard ratios (HR). CBA and RFA demonstrated equivalent freedom from any arrhythmia (RR 0.97, 95% CI 0.81–1.15; p = 0.71). Time‐to‐event analysis corroborated a comparable recurrence hazard (HR 0.91, 95% CI 0.67–1.24; p = 0.56; I 2 = 0%). Repeat ablation rates were identical (RR 0.93; p = 0.50). CBA significantly reduced procedural time (MD −45.37 min; p < 0.0001), while major complications were comparable (1.5% vs. 2.7%; p = 0.18). Trial sequential analysis indicated that further randomization is unlikely to demonstrate superiority. Conclusion: In PeAF, CBA and RFA achieve equivalent 12‐month arrhythmia‐free survival and comparable repeat‐ablation rates, while CBA confers a highly significant reduction in procedural time. However, reliance on 12‐month follow‐up and heterogeneous rhythm surveillance protocols may limit assessments of true long‐term durability.
SN - 0147-8389
SN - 1540-8159
ER -