Safety and efficacy of cryoballoon versus radiofrequency ablation for atrial fibrillation in elderly patients: A real-world evidence

Tauseef Akhtar; Ryan Wallace; Usama A Daimee; Bhradeev Sivasambu; Erica Hart; Eunice Yang; Joseph E Marine; Ronald Berger; Hugh Calkins; David Spragg

doi:10.1016/j.ipej.2021.11.006

Safety and efficacy of cryoballoon versus radiofrequency ablation for atrial fibrillation in elderly patients: A real-world evidence

Indian Pacing Electrophysiol J. 2022 Jan-Feb;22(1):24-29. doi: 10.1016/j.ipej.2021.11.006. Epub 2021 Nov 25.

Authors

Affiliations

¹ Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA. Electronic address: tausif.akhtar@gmail.com.
² Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.

Abstract

Background: There are limited data describing the experience of 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 RF vs. CB ablation between January 2014 and May 2020 at our center. The choice of ablation technique was left to the operator's discretion. Major complications and efficacy, defined as freedom from any atrial tachyarrhythmia (ATA) lasting ≥30 s after one year of follow-up, were assessed in patients with index RF vs. CB ablation.

Results: In our cohort of 186 patients, the median age was 78 (76-81) years, 54.8% were men, and 39.2% had persistent AF. The median CHA₂DS₂-VASc score was 4 (3-4), while the median duration of AF was 3 (1-7) years. The majority (n = 112, 60.2%) underwent RF ablation. The median procedure time was significantly lower in CB group (197 vs 226.5 min, p=<0.01). The incidence of complications was similar in the two sub-groups (RF: 1.8% vs. CB: 2.7%, p = 0.67). Similarly, arrhythmia-free survival rate on antiarrhythmic drugs at 1-year follow-up remained statistically comparable (63.4% vs. 68.9%, p = 0.33) between patients receiving RF vs. CB ablation.

Conclusion: The safety and efficacy of RF vs. CB ablation for AF remained comparable in our cohort of patients older than 75 years. CB ablation was associated with a shorter procedure time.

Keywords: Arrhythmia recurrence; Atrial fibrillation; Cryoballoon ablation; Elderly patients; Radiofrequency ablation; Transient phrenic nerve palsy.