In-hospital outcome of cryoballoon versus radio-frequency (RF)-energy ablation in patients with atrial fibrillation – insights from a national registry

Markus Jäckel (Freiburg im Breisgau)1, K. Kaier (Freiburg im Breisgau)1, D. Westermann (Freiburg im Breisgau)1, C. von zur Mühlen (Freiburg im Breisgau)1, A. Maier (Freiburg im Breisgau)1

1Universitäts-Herzzentrum Freiburg - Bad Krozingen Klinik für Kardiologie und Angiologie Freiburg im Breisgau, Deutschland


Pulmonary vein isolation (PVI) is a standard therapeutic approach for atrial fibrillation (AF), a chronic progressive disease with high prevalence. PVI can be performed by radiofrequency (RFA) or cryoballoon (CB) ablation procedures. The superiority of one of the two methods concerning complications has not yet been proven. Additionally, existing data comes from large centers. Since PVI is nowadays also routinely performed in smaller hospitals, real-world data comparing in-hospital outcome of RFA and CB is even more important. The purpose of this study was to analyze in-hospital outcome of RF and CB ablation in a nation-wide registry.

By the use of health records, we analyzed all RF and CB ablations of the pulmonary veins in Germany from 2013-2021. Safety performance endpoints included in-hospital mortality, bleeding, ventilation >48 hours, length of stay, pericardial effusion and puncture.

From 2013-2021, 264,320 (20,823 in 2013; 38,173  in 2021) RF and 129,474 (4,244 in 2013 and 25,521 in 2021) CB ablations of pulmonary veins were performed. No relevant differences were identified concerning baseline characteristics as age (RF: 64.1±12.6 vs CB: 64.8±10.8 years), sex (female 40.6% vs 41.3%), or charlson comorbidity index (CCI) (0.9±1.2 vs. 0.7±1.1). No relevant differences were identified concerning in-hospital mortality (0.09% vs. 0.07%), severe bleeding, stroke, MACCE (mortality/stroke/myocardial infarction) or ventilation >48 hours, while pericardial puncture was necessary significantly more often in RFA (1.05% vs. 0.50%). After adjustment for baseline characteristics, pericardial puncture occured significantly more often in patients with RFA (RR 0.62 (95% CI 0.54-0.69); p<0.001).

Frequency of RF and CB ablation increased clearly since 2013 in Germany. Both procedures have a comparable low procedural risk with a very low in-hospital mortality, while pericardial puncture is significantly more often necessary in patients with RFA.
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