Secondary outcomes favour cryoballoon ablation in paroxysmal AF
medwireNews: Reintervention and rehospitalisation rates are significantly lower with cryoballoon ablation than with radiofrequency current (RFC) catheter ablation in patients with symptomatic paroxysmal atrial fibrillation (AF), FIRE AND ICE study data show.
These findings “are clinically relevant and of importance from a patient disease burden and health economical point of view”, Karl-Heinz Kuck (Asklepios Klinik St Georg, Hamburg, Germany) and co-authors remark.
They explain that primary analyses in the randomised FIRE AND ICE trial showed that cryoballoon ablation was non-inferior to RFC ablation in terms of efficacy and safety when performed in patients with drug-refractory symptomatic paroxysmal AF.
In the current study, the researchers found that, during 30 months of follow-up, the repeat ablation rate was significantly lower in the 374 patients in the cryoballoon group, at 11.8%, than in the 376 patients in the RFC group, at 17.6%.
When the cryoballoon technique was used, there were also significantly fewer direct-current cardioversions (DCCVs; 3.2 vs 6.4%), all-cause rehospitalisations (32.6 vs 41.5%) and cardiovascular rehospitalisations (23.8 vs 35.9%).
Despite these differences, Kuck and team found that patients in both groups reported similar improvements in mental and physical quality of life – measured by the Short Form-12 health survey and the EuroQol five-dimension questionnaire – at 6 months after the index ablation that were maintained throughout the 30 months of follow-up.
Writing in the European Heart Journal, Kuck et al say: “The significant reductions in reinterventions such as repeat ablations and DCCVs indicate that the primary endpoint (i.e. time-to-first recurrence of atrial tachycardia or AF, re-initiation of antiarrhythmic drug therapy, or repeat ablation) does not fully reflect the benefit of catheter ablation in patients with AF and the technique used to achieve PVI [pulmonary vein isolation].”
They add: “In our analysis, cryoballoon ablation reduced all reintervention and rehospitalization endpoints to a significantly greater amount than RFC ablation, indicating a larger effect of cryoablation on healthcare burden reduction than compared with RFC ablation.”
The team concludes: “[T]his result should be considered when physicians need to decide which ablation modality (cryoballoon or RFC) should be selected for PVI in patients with AF.”
By Laura Cowen
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