Comparison of Cryoballoon and Ablation Index-Guided Radiofrequency Ablation in Paroxysmal Atrial Fibrillation

Background: Atrial fibrillation is the most common sustained arrhythmia worldwide. Pulmonary vein isolation (PVI) is the most effective catheter ablation technique for treating paroxysmal atrial fibrillation (pAF). Common ablation methods include point-by-point radiofrequency (RF) ablation and single-shot techniques such as cryoballoon ablation (CB). This single-center, prospective study aimed to compare the efficacy of ablation index-guided RF ablation (AI-RF) and CB in patients with symptomatic, antiarrhythmic-resistant pAF. Methods: A total of 154 patients undergoing initial PVI were divided into two groups (CB: 51, AI-RF: 103), based on the operators' decision. Procedural data (total procedure time, fluoroscopy time, radiation dose, complication rate) and recurrence rates were analyzed over a 12-month follow-up period. Results: The CB group had a significantly shorter total procedure time compared to the AI-RF group (64 [57; 74.8] minutes vs. 92 [76; 119] minutes; p < 0.001). However, the CB group experienced higher fluoroscopy times (559 [395; 868] seconds vs. 167 [126; 224] seconds; p < 0.001) and a greater fluoroscopy dose (21.8 [11.7; 40.1] mGy vs. 7.65 [5.21; 14.5] mGy; p < 0.001). Recurrence rates were similar during both the blanking period (11.7% vs. 10.7%; p = 0.84) and the 12-month follow-up period (22.7% vs. 13.4%; p = 0.22). No major complications were reported during this study. Conclusions: In this single-center study, there were no significant differences in long-term recurrence or complication rates between the CB and AI-RF groups for patients with antiarrhythmic-refractory, symptomatic pAF. While the CB group benefited from a significantly shorter procedure time, it required a higher fluoroscopy dose and a longer fluoroscopy time.