Vergleichende Single-Center basierte Analyse von Radiofrequenz- und Kryoablation von Vorhofflimmern hinsichtlich Effektivität und Sicherheit
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Background: Atrial fibrillation is one of the most common cardiac arrhythmias worldwide and is associated with an increased risk of stroke, heart failure, and cardiovascular mortality. Catheter ablation is a widely used treatment option for patients with symptomatic atrial fibrillation. Both cryoablation and radiofrequency (RF) ablation are well-established procedures; however, the literature provides inconsistent results regarding potential superiority in outcomes such as rehospitalization or freedom from recurrence. In addition, potential predictors of these endpoints require further investigation.
Methods: This retrospective single-center study included consecutive patients (n = 267) who underwent interventional rhythm control using cryo- or RF in a single-center setting. A detailed characterization of the cohort was performed, followed by follow-up of established parameters addressing efficacy and safety. Baseline, procedural, and echocardiographic parameters as well as clinical endpoints were statistically compared between the cryo- and RF groups. Furthermore, a binary logistic regression analysis was conducted to identify predictors of efficacy endpoints.
Results: Patients in the RF group were significantly older and more frequently had persistent or long-standing persistent atrial fibrillation. Comorbidities such as arterial hypertension, coronary artery disease, renal insufficiency, or hyperlipoproteinemia were also more common in the RF group. Left ventricular ejection fraction was significantly lower, while left atrial diameter was larger, and valvular disease was reported more often. No significant difference in safety endpoints was observed between the two procedures. Regarding efficacy, however, significantly more recurrences occurred in the RF group after the blanking period (16.6% [24/151] vs. 27.4% [31/116], p = .034) during a mean follow-up of 9.89 ± 12.53 months. In the cryoablation group, the need for a new antiarrhythmic drug prescription post-intervention was significantly lower (15.4% [23/151] vs. 29.3% [34/116], p = .006). In the overall logistic regression model, age, sleep-disordered breathing, and left atrial diameter were identified as predictors of recurrences within the blanking period, although none of the single-parameter logistic regression models reached statistical significance. For recurrences after the blanking period, at least moderate mitral regurgitation emerged as a significant predictor (p = .014). Higher age (p = .039) and larger left atrial diameter (p = .007) were predictive of rehospitalization due to atrial fibrillation. Moreover, higher age (p = .04) and larger left atrial diameter (p = .005) were significantly associated with assignment to RF ablation.
Conclusion: Cryoablation proved superior to RF ablation in several efficacy endpoints, such as recurrence-free survival after first ablation, while no difference in safety was observed. Patients in the cryoablation group also required new antiarrhythmic medication less frequently. These findings should be interpreted considering the higher age and comorbidity burden in the RF group, which may have contributed to less favorable outcomes. Predictors such as age, left atrial diameter, and mitral regurgitation should be carefully considered in clinical decision-making to reduce the risk of recurrence and rehospitalization. Given the heterogeneous study landscape and potential biases of the present retrospective analysis, further prospective randomized trials comparing ablation modalities are warranted.
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Issued: 2026-04-27
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FB20:Medizin
Language
de
Keywords
VorhofflimmernKryoablationRadiofrequenzablationSingle-Center
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Wipperfeld, Maik: Vergleichende Single-Center basierte Analyse von Radiofrequenz- und Kryoablation von Vorhofflimmern hinsichtlich Effektivität und Sicherheit. : 2026-04-27. DOI: https://doi.org/10.17192/openumr/678.
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This item has been published with the following license: In Copyright