Long-Term Results of the Effectiveness of Cryoballoon and Radiofrequency Ablation in Patients with Atrial Fibrillation: Propensity Score Matching Analysis

Aim To compare the long-term effectiveness of cryoballoon ablation (CBA) and radiofrequency ablation (RFA) in patients with atrial fibrillation (AF).Material and methods This retrospective single-site study included 597 patients with AF who had undergone CBA (n=241) or RFA (n=356) between 2016 and 2024. The study participants included 355 men (59.5%) and 242 women (40.5%) aged 58.4±10.8 years. The follow-up period was 13.0 [10.0; 27.5] months. The primary endpoint was late recurrence of AF (≥90 days after catheter ablation (CA)) confirmed by electrocardiography (ECG) or ECG Holter monitoring. To minimize confounding, the groups were compared by the propensity score matching (PSM, 234 pairs). The absence of AF recurrence was analyzed using Kaplan-Meier survival curves and group comparison with the log-rank test. Predictors for an increased risk of AF recurrence were identified by the univariate and multivariate Cox regression analysis. Results With the use of PSM, late AF recurrence was found in 41 (17.5%) patients after CBA and in 85 (36.3%) after RFA (p<0.001). Thus, at 48 months after CA, AF recurrence was absent in 70% of patients in the CBA group and 53% patients in the RFA group; the difference between the groups was statistically significant (log-rank p=0.005). In the multivariate Cox analysis, independent predictors of AF recurrence were body mass index (BMI) (odds ratio (OR) 1.11; 95% confidence interval (CI) 1.05-1.18; p<0.001) and early AF recurrence within 90 days (OR 4.43; 95% CI 2.72-7.21; p<0.001). Conclusion According to the study univariate analysis, CBA showed an advantage over RFA in terms of the efficacy in the long-term period. Body mass index and early AF recurrence were independent predictors of late AF recurrence after CA.