Pulmonary vein isolation using cryoballoon vs. optimized high-power short-duration: a propensity score study

Pulmonary vein isolation (PVI) is still the cornerstone for the catheter ablation of paroxysmal atrial fibrillation (AF). A combined radiofrequency (RF) approach using very high-power short-duration (vHPSD) posteriorly and ablation index guided high-power short-duration (HPSD) anteriorly has been recently shown to provide excellent profiles of effectiveness, safety and efficiency. The present study sought to compare with a propensity score match analysis vHPSD/HPSD ablation to cryoballoon (CB) ablation in patients with paroxysmal AF.

All patients having undergone PVI as the index procedure for paroxysmal AF were consecutively included. A 1 : 1 propensity score matching was carried out including age, gender, arterial hypertension, diabetes, left atrial diameter, and left ventricular ejection fraction in the logistic regression model.

Ninety-six patients who had undergone RF were matched and compared with 96 patients who had undergone CB ablation. The mean age was 61.8 ± 9.8 years (142 males, 74%). Over a mean follow-up of 22.6 ± 5.9 months, freedom from atrial tachyarrhythmias was achieved in 75% of patients (72/96) in the CB group and in 84.4% of patients (81/96) in the RF group (P = 0.1). One cerebrovascular event (1.0%) treated with mechanical thrombectomy and four phrenic nerve palsies (4.2%), which recovered within 1 year, occurred in the CB group. Procedure times were similar (88.6 ± 14.0 vs. 92.1 ± 12.1 min, P = 0.1), but the fluoroscopy time was shorter in the vHPSD/HPSD group (10.8 ± 2.5 vs. 4.9 ± 1.8 min, P < 0.01).

The optimized workflow in a setting of a hybrid RF approach of vHPSD/HPSD made point-by-point PVI as fast, safe and effective as CB ablation.