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Radiofrequency versus Cryoballoon Ablation for the Treatment of Atrial Fibrillation: A Comprehensive Systematic Review and Meta-analysis of Randomized Controlled Trials
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  • Mohamed Diaa,
  • Haya A. Ahmed,
  • Abdelfattah Fathy Abu-bakr,
  • Karim Ali,
  • Nada Osama Aboelmagd,
  • Muhammad Kamal Eldeen Muhammad,
  • Mohammed Ramadan Abdelnasser,
  • Manar Maarouf Abuelkasem,
  • Omar Mohamed Farouk,
  • Youssef Ahmed Fahmy,
  • Kerollos Abdelsayed
Mohamed Diaa
South Valley University Faculty of Medicine

Corresponding Author:[email protected]

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Haya A. Ahmed
South Valley University Faculty of Medicine
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Abdelfattah Fathy Abu-bakr
South Valley University Faculty of Medicine
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Karim Ali
Hennepin Healthcare Research Institute
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Nada Osama Aboelmagd
South Valley University Faculty of Medicine
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Muhammad Kamal Eldeen Muhammad
South Valley University Faculty of Medicine
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Mohammed Ramadan Abdelnasser
South Valley University Faculty of Medicine
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Manar Maarouf Abuelkasem
South Valley University Faculty of Medicine
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Omar Mohamed Farouk
South Valley University Faculty of Medicine
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Youssef Ahmed Fahmy
South Valley University Faculty of Medicine
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Kerollos Abdelsayed
Minneapolis Heart Institute Foundation
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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.