Safety and Efficacy of Cryoballoon versus Radiofrequency Ablation for
Atrial Fibrillation in Elderly Patients and Predictors of Arrhythmia
Recurrence
Abstract
Introduction: There are limited data describing the experience of index
radiofrequency (RF) vs. cryoballoon (CB) ablation for atrial
fibrillation (AF) among elderly patients in the United States. Methods:
We conducted a retrospective analysis of patients > 75
years of age undergoing index AF ablation between January 2010 and March
2019 at our center. Major complications and efficacy, defined as freedom
from any atrial tachyarrhythmia (ATA) lasting ≥30 seconds after one year
of follow-up, were assessed in patients with index RF vs. CB ablation.
Predictors of ATA recurrence at 1 year follow-up were also evaluated.
Results: In our cohort of 194 patients, the mean age was 78 ± 3.1 years,
58.2% were men, and 39.4% had persistent AF. The mean left atrial (LA)
diameter was 4.5 ± 0.7, while the mean CHA2DS2-VASc score was 3.5 ± 1.2.
The majority (n=149, 76.8%) underwent RF ablation. The incidence of
complications was similar in the two sub-groups (RF: 1.3% vs. CB:
2.2%, p=0.67). No significant difference in success rate at 1-year
follow-up was found between patients receiving RF vs. CB ablation
(59.7% vs. 66.7%, p=0.68). In a multivariable model adjusting for the
relevant covariates only LA size [HR=1.64, CI: 1.15-2.34,
p<0.01] was independently associated with ATA recurrence at
1year follow-up. Conclusion: In our cohort of elderly patients
undergoing index CA for AF, RF ablation was the predominant modality
with similar safety and efficacy relative to CB ablation. LA size was a
significant predictor of ATA recurrence at 1year independent of index
ablation modality.