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Atrial fibrillation progression after cryoablation vs. radiofrequency ablation: the CIRCA-DOSE trial
Jason G Andrade1,2,3, Marc W Deyell2, Paul Khairy3
1Department of Medicine, University of British Columbia, 2775 Laurel St 10th Floor, Vancouver, BC V5Z 1M9, Canada.
Insights
Contact-force radiofrequency ablation for atrial fibrillation (AF) showed a lower rate of progression to persistent AF compared to cryoballoon ablation. This study highlights the importance of ablation energy type in managing AF progression.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Atrial fibrillation (AF) is a progressive disorder linked to severe health outcomes.
- Catheter ablation aims to modify AF progression mechanisms.
- The impact of different ablation energies on AF progression remains unevaluated in randomized trials.
Purpose of the Study:
- To compare the efficacy of contact-force radiofrequency (CF-RF) ablation versus cryoballoon ablation (CRYO-4 and CRYO-2) in preventing the progression of paroxysmal atrial fibrillation to persistent atrial tachyarrhythmia.
Main Methods:
- 346 patients with drug-refractory paroxysmal AF were randomized into three groups: CF-RF ablation, 4-minute cryoballoon ablation, or 2-minute cryoballoon ablation.
- Implantable cardiac monitors were used for follow-up.
- The primary endpoint was the first episode of persistent atrial tachyarrhythmia.
Main Results:
- No patients (0.0%) in the CF-RF group developed persistent atrial tachyarrhythmia, compared to 7.0% in the CRYO-4 group and 4.3% in the CRYO-2 group (P = .03).
- Recurrence of any atrial tachyarrhythmia (≥30s) and reduction in AF burden were similar across all groups.
- Median follow-up was 944 days.
Conclusions:
- Catheter ablation using radiofrequency energy was associated with a significantly lower rate of progression to persistent atrial fibrillation.
- These findings suggest that the type of ablation energy may influence the long-term management of atrial fibrillation progression.
Background And Aims:
Atrial fibrillation (AF) is a chronic progressive disorder. Persistent forms of AF are associated with increased rates of thromboembolism, heart failure, and death. Catheter ablation modifies the pathogenic mechanism of AF progression. No randomized studies have evaluated the impact of the ablation energy on progression to persistent atrial tachyarrhythmia.
Methods:
Three hundred forty-six patients with drug-refractory paroxysmal AF were enrolled and randomly assigned to contact-force-guided RF ablation (CF-RF ablation, 115), 4 min cryoballoon ablation (CRYO-4, 115), or 2 min cryoballoon ablation (CRYO-2, 116). Implantable cardiac monitors placed at study entry were used for follow-up. The main outcome was the first episode of persistent atrial tachyarrhythmia. Secondary outcomes included atrial tachyarrhythmia recurrence and arrhythmia burden on the implantable monitor.
Results:
At a median of 944.0 (interquartile range [IQR], 612.5-1104) days, 0 of 115 patients (0.0%) randomly assigned to CF-RF, 8 of 115 patients (7.0%) assigned to CRYO-4, and 5 of 116 patients (4.3%) assigned to CRYO-2 experienced an episode of persistent atrial tachyarrhythmia (P = .03). A documented recurrence of any atrial tachyarrhythmia ≥30 s occurred in 56.5%, 53.9%, and 62.9% of those randomized to CF-RF, CRYO-4, and CRYO-2, respectively; P = .65. Compared with that of the pre-ablation monitoring period, AF burden was reduced by a median of 99.5% (IQR 94.0%, 100.0%) with CF-RF, 99.9% (IQR 93.3%-100.0%) with CRYO-4, and 99.1%% (IQR 87.0%-100.0%) with CRYO-2 (P = .38).
Conclusions:
Catheter ablation of paroxysmal AF using radiofrequency energy was associated with fewer patients developing persistent AF on follow-up.
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