Patients with symptomatic paroxysmal atrial fibrillation (afib) have lower rates of rehospitalizations if they get cryoablation instead of radiofrequency (RF) catheter ablation.
The rehospitalization rate was 32.6% with the cryoballoon versus 41.5% with RF ablation (log-rank P=0.01) in secondary findings of the FIRE AND ICE trial reported at the Cardiostim-EuroPace meeting in Nice, France.
Though Karl-Heinz Kuck, MD, PhD, of St. Georg Hospital in Germany, presented improvements in quality-of-life with both treatments over 30 months of follow-up, recipients of cryoablation had fewer:
- Cardiovascular rehospitalizations (23.8% versus 35.9%, log-rank P<0.01)
- Repeat ablations (11.8% versus 17.6%, log-rank P=0.03)
- Direct current cardioversions (3.2% versus 6.4%, log-rank P=0.04)
Patients with no history of direct current cardioversion had fewer cardiovascular rehospitalizations over follow-up (24.7% with cryoballoon versus 31.9% with RF catheter, P<0.01). The odds were borderline for those with prior direct current cardioversion (20.9% versus 48.9%, P=0.05).
“The secondary analyses [of FIRE AND ICE] favor cryoballoon over [RF ablation], with important implications on daily clinical practice,” the investigator said.
In a prior report of FIRE AND ICE’s primary analysis, Kuck and colleagues showed cryoablation to be non-inferior to RF ablation for the primary efficacy and safety endpoints. The study included 762 patients who were randomized to RF catheter ablation or cryoablation.
“While the learning curve and reproducibility of any technology are very important, what FIRE AND ICE has shown is that, for most operators, cryoballoon may be a safer and more efficient approach for initial treatment of paroxysmal afib,” Wilber Su, MD, of Banner-University Medical Center in Phoenix, told MedPage Today.
“Cryoballoon has already become the preferred approach in my practice, both from personal experience as well as patient demand,” he added.
Either way, “being comfortable with the technology of choice to maximize procedural safety and outcome is the most critical part of clinical care,” concluded Su, who was not part of the trial. “For RF, operator dependence likely may play a bigger role. For cryoballoon, while the outcome may have shown less adverse outcomes compared to that of RF, it is still not zero. Operators needs to make a strong effort to minimize harm with any technology.”
The FIRE AND ICE trial was funded by Medtronic.
Kuck disclosed receiving consulting fees and honoraria from Biosense Webster, Edwards Lifesciences, St. Jude Medical; as well as serving on the speaker’s bureau of Medtronic.
Su reported receiving research support, speaker’s fees, and honoraria from Medtronic and St. Jude Medical.
Kuck K “The FIRE AND ICE trial secondary analyses: reintervention, rehospitalization, and quality-of-life outcomes” Cardiostim 2016.