Head-to-head: Cryoballoon vs radiofrequency ablation in persistent AF

Cryoballoon and radiofrequency ablation had similar atrial tachyarrhythmia outcomes at 1-year post-ablation in patients with persistent atrial fibrillation (AF). However, findings from the randomised-controlled CRRF-PeAF trial indicated that radiofrequency ablation may have a more substantial reversed remodelling effect than cryoballoon ablation.

The CRRF-PeAF trial compared cryoballoon and radiofrequency ablation in a large cohort of patients with persistent AF. The 500 participants were randomised 1:1 to cryoballoon ablation or radiofrequency ablation. The primary endpoint was the occurrence of atrial tachyarrhythmias at 1 year of follow-up. Dr Kengo Kusano (National Cerebral and Cardiovascular Center, Japan) presented the results [1].

No difference was seen in the primary endpoint between the 2 arms (HR 0.99; 95% CI 0.69–1.43; P_logrank=0.96). This finding was consistent across subgroups. “We did, however, see a significant reduction in left atrial volume index in the radiofrequency group as compared with the cryoballoon group at 1-year post-ablation, suggesting that the 2 ablation techniques have a different impact on reverse remodelling,” added Dr Kusano (see Figure). “A possible explanation for the different impact of radiofrequency ablation and cryoballoon ablation is the fact that cryoballoon ablation is associated with wider, more continuous lesions than radiofrequency ablation, which may result in more injury to the myocardium, leading to a less pronounced atrial remodelling.”

Figure: Left atrial volume index at baseline and 1-year post ablation [1]



“Cryoballoon and radiofrequency ablation yielded similar arrhythmia outcomes in patients with persistent AF,” concluded Dr Kusano. “Although we know that cryoballoon ablation has a shorter procedure time than radiofrequency ablation, the latter was associated with inducing more profound structural changes to the left atrium.”

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   1. Kusano K, et al. Cryoballoon ablation versus radiofrequency ablation in patients with persistent atrial fibrillation (CRRF-PEAF): a prospective, multicenter, randomised, non-inferiority clinical trial. LBS.07, AHA Scientific Sessions 2024, 16–18 November, Chicago, USA.

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Posted on 3 February 2025