Radiofrequency versus Cryoballoon Ablation for the Treatment of Atrial
Fibrillation: A Comprehensive Systematic Review and Meta-analysis of
Randomized Controlled Trials
Abstract
Background Determining the safer and more effective ablation
technique for atrial fibrillation (AF) remains a matter of concern.
Thus, in this meta-analysis, we evaluated radiofrequency ablation (RFA)
and cryoballoon ablation (CA) through randomized controlled trials
(RCTs) comparing the two techniques in terms of freedom from AF, any
tachyarrhythmia recurrence, stroke, phrenic nerve palsy (PNP), procedure
duration, and mortality. Methods A PubMed, Scopus, Web of
Science, and Cochrane literature search was conducted from inception
until December 2024. RCTs comparing RFA versus CA for AF were selected.
All relevant outcomes were pooled in the meta-analysis using Review
Manager Software. Results We included 23 RCTs with a total of
3018 patients. Both types of ablations were comparable regarding freedom
from AF and recurrence of any atrial tachyarrhythmias (RR = 0.99, 95%
CI (0.90, 1.09), P = 0.90; RR = 0.94, 95% CI (0.82, 1.08), P =0.38,
respectively). Likewise, both ablation techniques showed a comparable
risk of stroke and mortality (RR = 0.51, 95% CI (0.26, 1.01), P = 0.05;
RR = 0.27, 95% CI (0.04, 1.61), P = 0.15). Regarding safety, PNP was
significantly lower with RF (RR = 0.36, 95% CI (0.24, 0.54), P
< 0.00001). However, the procedure was significantly longer
than CA (MD = 17.91, 95% CI (7.85, 27.98), P = 0.0005).
Conclusion RFA and CA have comparable efficacy outcomes for
rhythm control in AF but have unique procedural and safety profiles. The
choice between these modalities should be guided by clinical context,
operator expertise, and patient-specific considerations. Further
research, particularly in high-risk populations and with evolving
ablation technologies, is essential to refine these insights and
optimize patient outcomes.