Cryoablation Versus Hybrid Radiofrequency with High and Very-High Power Short Duration Catheter Ablation for the Treatment of Paroxysmal Atrial Fibrillation.

BACKGROUND: High-power short duration(HPSD) and very high-power short duration(vHPSD-90W/4s) radiofrequency(RF) technology has reduced the procedure time of pulmonary vein isolation(PVI) using RF without compromising the efficacy of the technique. The current study compares the novel technology of HPSD/vHPSD with cryoablation(CRYO) in terms of efficacy, safety and procedure time in a cohort of symptomatic patients with paroxysmal atrial fibrillation(pAF).

METHODS: This is a prospective non-randomized trial. Patients with pAF received either CRYO or HPSD/vHPSD RF PVI. The primary endpoint of the study was arrhythmia recurrence in 12 months follow-up period. Secondary endpoints included procedure time, fluoroscopy time and safety.

RESULTS: 104 patients were included (45 in HPSD/vHPSD and 59 in CRYO), with comparable characteristics between groups. The follow-up was 12.4 +/- 0.5 months. There was no significant difference regarding arrhythmia recurrences during the early post-procedural period of first 3 months (8.9% recurrences in HPSD/vHPSD versus 5.1% in CRYO-p 0.463) and in the mid-term follow up of 12 months (17.8% recurrences in HPSD/vHPSD versus 10.2% in CRYO-p 0.385). Safety was excellent for both procedures. CRYO was a procedure of significantly shorter duration (64.64±8.94 min versus 75.29±18.30min, p 0.0001) at the expense of longer fluoroscopy time (HPSD/vHPSD 5.34±1.83 versus 7.89±3.70min CRYO, p 0.001).

CONCLUSIONS: HPSD/vHPSD and CRYO in pAF were comparable regarding the arrhythmia recurrence rates in a 12 months follow-up with excellent safety. The hybrid approach of HPSD/vHPSD has accelerated RF-PVI, compared to conventional RF, but CRYO remains a procedure of significantly shorter duration at the expense of longer fluoroscopy time.