Cryoballoon Versus Radiofrequency Ablation For Paroxysmal Atrial Fibrillation:A Systematic Review

Objective: To investigate the difference of effective and safety between cryoballoon ablation(CBA) and radiofrequency catheter ablation(RFA) in the treatment of paroxysmal atrial fibrillation.Method: The clinical control trials of cryoballoon ablation and radiofrequency catheter ablation in the treatment of paroxysmal atrial fibrillation(PAF) were enrolled from Medline, Cochrane Library, Embase Database, Web of Science and Clinical Trials.gov. The primary outcomes were determined as the recurrence rate of atrial tachycardia after one year follow-up. Secondary outcomes were the rate of major complications such as phrenic nerve paralysis(PNP), pericardial tamponade and stroke/TIA. The meta-analysis was accomplished with Revman5.3.Results: There were 6152 patients form 9 prospective randomized controlled trial and 3 cohort studies were enrolled. The primary outcomes, there were some statistical differences between CBA group and RFA group(OR: 0.77; 95% CI: 0.60 to 0.97, P =0.03; I~2= 33%, P = 0.15).As for the secondary outcomes were also no statistic difference in both recurrence rate of 3/6 months follow-up and the total incidence of major complications(OR: 19.50; 95% CI:8.30 to 45.86, P <0.00001; I~2= 0%, P = 0.59).But, the risk of phrenic nerve paralysis in group CBA was much higher than that in group RFA(OR: 19.50; 95% CI:8.30 to 45.86, P <0.00001; I~2= 0%, P = 0.59),and the risk of pericardial effusion in group CBA was lower than that in group RFA(OR: 0.58; 95% CI:0.35 to 0.96, P =0.03; I~2= 0%, P = 0.91).Conclusion: Compared with RFA, CBA has lower long term follow-up recurrence rate and pericardial effusion risk in the treatment of paroxysmal atrial fibrillation. However, the incidence of PNP is also increased. There are no significant difference between CBA and RFA in both short-term follow-up recurrence rate and other adverse events.