Cryoballoon versus Radiofrequency Catheter Ablation in Atrial Fibrillation: A Meta-Analysis

Rhanderson Cardoso, Rodrigo Mendirichaga, Gilson Fernandes, Chris Healy, Litsa K. Lambrakos, Juan F. Viles-Gonzalez, Jeffrey J. Goldberger, Raul D. Mitrani

Research output: Contribution to journalArticlepeer-review

55 Scopus citations


Introduction: Radiofrequency (RF) and cryoballoon (CB) catheter ablation are effective for pulmonary vein isolation (PVI) in atrial fibrillation (AF). This report presents an updated meta-analysis comparing the efficacy and safety of CB versus RF ablations in AF. Methods: Databases and conference abstracts were systematically searched for studies that directly compared CB and RF PVI, and reported safety or efficacy outcomes in follow-up ≥12 months. Recurrent atrial tachyarrhythmias (AT) were defined as AF, atrial flutter, or atrial tachycardia. Results: Twenty-two studies and 8,668 patients were included. Freedom from AT was not significantly different between CB and RF ablations in the pooled population (OR 1.12; 95%CI 0.97–1.29; P = 0.13) and in randomized trials (OR 1.0; 95%CI 0.65–1.56; P = 0.99). Second-generation CB (CB2; 78.1%) and contact-force (CF) sensing RF (78.2%) have improved procedure success rate as compared to first-generation technology (57.9% CB, 58.1% RF). As compared to CF-RF, CB2 demonstrated similar freedom from recurrent AT (OR 1.04; 95%CI 0.71–1.51; P = 0.84). The incidence of pericardial effusions (OR 0.44; 95%CI 0.28–0.69; P < 0.01), tamponade (OR 0.31; 95%CI 0.15–0.64; P < 0.01), and non-AF AT (OR 0.46; 95%CI 0.26–0.83; P < 0.01) were significantly lower with CB ablation, whereas transient phrenic nerve palsy was more incident after CB (OR 7.40; 95%CI 2.56–21.34; P < 0.01). Conclusion: There was comparable freedom from AT between CB and RF in patients with AF undergoing PVI. Additionally, freedom from AT was similar between CB2 and CF-RF. However, CB was associated with a lower incidence of pericardial effusions or tamponade, albeit with a higher rate of transient phrenic nerve palsies.

Original languageEnglish (US)
Pages (from-to)1151-1159
Number of pages9
JournalJournal of Cardiovascular Electrophysiology
Issue number10
StatePublished - Oct 1 2016


  • atrial fibrillation
  • catheter ablation
  • complication
  • cryoballoon
  • pulmonary vein isolation
  • radiofrequency

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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