The efficacy and safety of cryoballoon atrial fibrillation ablation in patients with heart failure: A systematic review and meta-analysis

Nithi Tokavanich; Witina Techasatian; Narut Prasitlumkum; Wisit Cheungpasitporn; Leenhapong Navaravong; Krit Jongarangsin; Ronpichai Chokesuwattanaskul

doi:10.1016/j.ipej.2024.01.001

The efficacy and safety of cryoballoon atrial fibrillation ablation in patients with heart failure: A systematic review and meta-analysis

Indian Pacing Electrophysiol J. 2024 Jan 12:S0972-6292(24)00001-9. doi: 10.1016/j.ipej.2024.01.001. Online ahead of print.

Authors

Nithi Tokavanich¹, Witina Techasatian², Narut Prasitlumkum³, Wisit Cheungpasitporn⁴, Leenhapong Navaravong⁵, Krit Jongarangsin¹, Ronpichai Chokesuwattanaskul⁶

Affiliations

¹ Division of Cardiovascular Medicine, Frankel Cardiovascular Center, University of Michigan Health, Ann Arbor, MI, USA.
² Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA.
³ Department of Cardiology, University of California Riverside, Riverside, CA, USA.
⁴ Department of Medicine, Mayo Clinic, Rochester, MN, USA.
⁵ Intermountain Heart Institute - Utah Valley, Provo, UT, USA.
⁶ Division of Cardiovascular Medicine, Department of Medicine, Cardiac Center, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand. Electronic address: drronpichaic@gmail.com.

PMID: 38218450
DOI: 10.1016/j.ipej.2024.01.001

Abstract

Introduction: While atrial fibrillation (AF) ablation has proven beneficial for heart failure (HF) patients, most reports were performed with radiofrequency ablation. We aimed to evaluate the efficacy and safety of cryoballoon AF ablation in patients with HFrEF.

Method: We comprehensively searched the databases of MEDLINE, EMBASE, and Cochrane database from inception to December 2022. Studies that reported the outcomes of freedom from atrial arrhythmia, complications, NYHA functional class (NYHA FC), and left ventricular ejection fraction (LVEF) after Cryoballoon AF ablation in HF patients were included. Data from each study were combined with a random-effects model.

Result: A total of 9 studies observational studies with 1414 HF patients were included. Five studies had only HF with reduced ejection fraction (HFrEF), 1 study with HF with preserved ejection fraction (HFpEF), and others with mixed HF types. Freedom from AA in HFrEF at 12 months was 64% (95% CI 56-71%, I² 58%). There was a significant improvement of LVEF in these patients with a standard mean difference of 13% (95% CI 8.6-17.5%, I² 99% P < 0.001. The complication rate in HFrEF group was 6% (95% CI 4-10%, I² 0%). The risk of recurrence of atrial arrhythmia was not significantly different between HF and no HF patients (RR 1.34, 95% CI 0.8-2.23, I2 76%).

Conclusion: Cryoballoon AF ablation is effective in HFrEF patients comparable to radiofrequency ablation. The complication rate was low.

Keywords: Atrial fibrillation; Cryoablation; Cryoballoon ablation; Heart failure.