Direct Comparison Between Second-Generation Cryoballoon Ablation Versus Contact Force-Sensing Radiofrequency Ablation in Paroxysmal Atrial Fibrillation Patients: A Systematic Review and Meta-Analysis Study

Background Pulmonary vein isolation (PVI) is the main ablation approach for paroxysmal atrial fibrillation (AF). The superiority of the second-generation cryoballoon (2G-CB) ablation over contact force-sensing radiofrequency (CF-RF) ablation is unclear. Therefore, we sought to investigate the superiority of 2G-CB ablation over CF-RF ablation in paroxysmal AF patients. Methods A systematic review and meta-analysis study was conducted. We included 12 studies involving 1419 patients. The overall effects were quantified using pooled odds ratio (OR) or mean difference (MD) for categorical or continuous variables. Results Freedom from atrial tachyarrhythmias (ATAs) (OR = 0.88; 95% confidence interval [CI] = 0.68 to 1.15; p = 0.35), freedom from AF (OR = 0.93; 95% CI = 0.64 to 1.34; p = 0.7), and acute PVI (OR = 1.00; 95% CI = 1.00 to 1.00; p = 0.99) between 2G-CB ablation and CF-RF ablation were not different. The 2G-CB ablation took shorter procedure time (MD = -18.78 minutes; 95% CI = -27.72 to -9.85 minutes; p < 0.01) and relative similar fluoroscopy time (MD = 2.66 minutes; 95% CI = -0.52 to 5.83 minutes; p = 0.10). Phrenic nerve paralysis was higher in 2G-CB ablation group (OR = 7.25; 95% CI = 2.37 to 22.16; p = < 0.005). Conclusion The 2G-CB ablation was not superior to CF-RF ablation in paroxysmal AF in terms of acute PVI, freedom from ATAs, and freedom from AF. The 2G-CB ablation procedure can be performed faster than CF-RF ablation, although correlated with a higher phrenic nerve paralysis.