Cryoballoon vs. Robotic Magnetic Navigation-Guided Radiofrequency Ablation in Patients with Persistent Atrial Fibrillation: 5-year outcomes

Background This study aimed to evaluate the long-term efficacy and clinical outcomes of catheter ablation performed with cryoballoon (CRYO) in comparison with robotic magnetic navigation (RMN) in patients with persistent atrial fibrillation (PersAF). Methods and Results A total of 200 patients with symptomatic PersAF were prospectively enrolled and assigned (1:1) to the CRYO or RMN guided-ablation group and then followed up over 5 years. The primary endpoint was freedom from atrial tachyarrhythmias (ATs) recurrence following a 3-month blanking period after the initial procedure. The secondary endpoints consisted of all-cause and cardiovascular rehospitalizations, rates of electrical cardioversions (ECs) and repeat ablations, new-onset neurological events, major bleeding events and the difference in CHA ₂ DS ₂ -VASc score at 5-year compared with baseline. After a median follow-up period of 60 months, 184 patients (93 in RMN, 91 in CRYO) completed the follow-up. Freedom from recurrent ATs was achieved in 44 out of 93 patients in the RMN group and 37 out of 91 patients in the CRYO group (47.3% vs. 40.7%, P = 0.32). There were no significant differences in the risk of all-cause and cardiovascular rehospitalizations, rates of ECs and repeat ablations, new-onset neurological events, and major bleeding at 5 years. OAC discontinuation was relatively common after ablation, 48.4% of patients with a CHA ₂ DS ₂ -VASc score ≥ 2 not on OAC therapy. Conclusion CRYO is comparable to RMN-guided ablation with respect to long-term freedom from ATs in patients with PersAF. Discontinuation of OAC after ablation is not rare even in patients at risk of stroke for continued OAC therapy.