Comparison of Cryoballoon Versus Radiofrequency Ablation in Persistent Atrial Fibrillation: Procedural Characteristics, Outcomes, and Predictors of Recurrence

Background: Persistent atrial fibrillation (AF) remains difficult to manage due to advanced atrial remodeling and higher recurrence rates following ablation. Cryoballoon ablation (CBA) and radiofrequency ablation (RFA) are the two most widely used modalities for pulmonary vein isolation. Objectives: To compare procedural characteristics, 12-month arrhythmia-free survival, and independent predictors of recurrence between CBA and RFA in patients with persistent AF. Methods: A retrospective single-center cohort study including 90 patients undergoing first-time ablation for persistent AF (CBA n=45; RFA n=45). Procedural parameters, complications, and rhythm outcomes were assessed. Recurrence was defined as atrial tachyarrhythmia lasting >30 seconds beyond a 90-day blanking period. Results: CBA demonstrated significantly shorter procedure time but required higher contrast volume and resulted in greater fluoroscopy exposure compared with RFA. At 12 months, arrhythmia-free survival was comparable between groups. Independent predictors of recurrence were AF duration >12 months and early recurrence during the blanking period. Conclusion: CBA and RFA provide similar efficacy for rhythm control in persistent AF. Procedural selection may be guided by workflow efficiency, atrial substrate characteristics, and patient-specific factors.