Radiofrequency Current Versus Balloon-Based Ablation for Atrial Fibrillation

The basis for selection of contemporary ablation technologies for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) remains unclear. We compared procedural data and efficacy in a propensity score-matched cohort treated with 4 ablation technologies in a center mainly using cryoballoon (CB). A total of 819 consecutive patients with AF underwent PVI, using radiofrequency current (RFC) (65 patients), CB (693 patients), hot balloon (HB) (74 patients), and laser balloon (LB) (52 patients). Fifty patients (82% paroxysmal AF) were selected from each group according to the propensity score. Procedural data and freedom from atrial tachyarrhythmia recurrence after the index procedure were compared. All pulmonary veins were isolated in all groups. Procedure time was shorter in CB and HB groups (RFC: 148 ± 53 vs CB: 85 ± 37 vs HB: 102 ± 31 vs LB: 140 ± 28 minutes, p <0.001). RFC touch-up was most commonly required for PVI in the HB group among balloon groups (40%) (p <0.001). Total complication rate was 4% to 18% without any statistical differences between groups (p = 0.123). Phrenic nerve injury occurred most often in the CB group (16%) (p <0.001). During a mean follow-up of 21 ± 6 months, there were no significant differences among groups for freedom from atrial tachyarrhythmia recurrence after the index procedure (RFC: 68% vs CB: 78% vs HB: 76% vs LB: 76%, p = 0.440). In conclusion, all the ablation technologies facilitate safe and efficient PVI, with slight differences in the procedural data and complications.