Which Treatment for Atrial Fibrillation: the “Hot Patootie” or “Mr. Freeze”?

By Todd J. Cohen, M.D.

In this month’s Journal of Invasive Cardiology, the Winthrop University Hospital Electrophysiology team presented an “Early Experience With the Cryoablation Balloon Procedure for the Treatment of Atrial fibrillation by an Experienced Radiofrequency Catheter Ablation Center” (see Mandell et al, Vol. 25 No. 6).  Our team retrospectively compared 62 radiofrequency (RF) catheter ablation procedures with 62 ablation procedures performed with the Arctic Front® Cardiac CryoAblation balloon catheter from Medtronic Inc., Minneapolis, MN. Patient and procedural characteristics and immediate success were compared.  Immediate failure was defined as incomplete pulmonary vein isolation of all veins.

Our early experience showed comparable outcomes with cryoablation and RF ablation.  The immediate success rate was 93.5% with RF catheter ablation and 96.7% with cryoablation (P=NS).  There were no significant differences in complications. This study showed no decrease in procedural or fluoroscopy times with our early experience. The procedural times were longer with cryoablation, but as would be expected, the time difference narrowed when factoring in the learning curve.  It is also worth noting that the cryoablation group did allow an occasional “touch-up” with RF catheter ablation. The cryoablation procedure did result in a 30% additional cost to the hospital procedure. This cost increment could be reduced by streamlining the cryoablation procedure and using a lesser number of ancillary catheters.

In conclusion, cryoablation (“Mr. Freeze”) and RF catheter ablation (“Hot Patootie”) are comparable. Their use can be synergistic in tackling the full gamut of atrial fibrillation (i.e. paroxysmal and persistent).

Todd J. Cohen, M.D., Principal investigator of the study

Director of Electrophysiology

Winthrop Cardiology Associates

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