Radiofrequency Catheter Ablation And Cryoballoon Ablation For Atrial Fibrillation

Objective:To compare the efficacy and safety of radiofrequency catheter ablation?RFCA?and cryoballoon ablation?CBA?in patients with atrial fibrillation?AF?,and explore the independent risk factors of recurrence after ablation.Methods:One hundred and twenty AF patients[mean age?61.6±9.9?yrs,76 males]treated in the First Affiliated Hospital of Soochow University from April 1,2016 to July 1,2017 were enrolled in the study.They were divided into two groups according to different ablation techniques,the RFCA group?n=60?and the CBA group?n=60?.The baseline data were compared between two groups.After a mean follow-up of?16.1±6.1?months,the Kaplan-Meier survival analysis was used to compare the recurrence rates between CBA group and RFCA group.Cox multivariate regression analysis was used to explore the independent risk factors for AF recurrence after ablation.The receiver operating characteristic curve?ROC?was used to assess the predictive value of left atrial diameter?LAD?for AF recurrence.Results:1 RFCA group had a higher proportion of atrial flutter?AFL?than CBA group?P<0.05?,while no significant differences were found in age,gender,body mass index?BMI?,AF type,AF duration,CHA₂DS₂-VASc score,history of hypertension,diabetes,smoking,drinking,beta blockers,amiodarone and propafenone at discharge between two groups?all P>0.05?.2 There were 6 cases?5.0%?of ablation-related complications in total,two cases?3.3%?had hematoma in RFCA group,three cases?5.0%?experienced vagal reaction and one case?1.7%?had phrenic nerve paralysis in CBA group.3 After a mean follow-up of?16.1±6.1?months,26?21.7%?cases experienced AF recurrence,11?18.3%?cases in RFCA group and 15?25.0%?cases in CBA group.There was no significant difference in recurrence rate between the two groups?Log-Rank P=0.369?.The non-recurrence rates at 3,6,12 and 18 months after ablation were 91.7%,88.3%,83.3%and 81.7%in the RFCA group,and 90.0%,83.3%,81.7%and 75.0%in the CBA group.4Cox multivariate regression analysis showed that LAD?HR=1.151,P=0.010?and persistent AF?HR=5.180,P<0.001?were independent risk factors for AF recurrence.5 The ROC curve showed the predictive value of LAD for AF recurrence[area under the curve?AUC?=0.777,95%CI?0.671⁰.882?,P<0.001].The cut-off point was 43 mm,with a sensitivity of 76%and specificity of 73.6%.There was a significant difference in recurrence between persistent AF and paroxysmal AF?Log-Rank P<0.001?.Conclusion:1 RFCA and CBA for AF are effective and safe.2 No significant difference was found in AF recurrence between two groups,LAD and persistent AF were independent risk factors for AF recurrence after ablaton.