Comparison of Short- and Long-term Outcomes of AF Patients Treated With Cryoballoon Ablation or Radiofrequency Ablation in a 2-Year Hospital Registry

Document Type : Original Article


1 Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

2 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.


Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Rhythm control is a treatment option. Ablation is done via 2 different methods: radiofrequency (RF) ablation and cryoballoon ablation. An evaluation of the outcome of these methods in a tertiary center is necessary.
Methods: This historical cohort study recruited 299 patients undergoing ablation. RF was performed on 150 patients, while 149 underwent cryoballoon ablation. Age, sex, risk factors (diabetes mellitus, hypertension, and renal failure), symptoms (palpitations, dyspnea, bradycardia, dizziness, and chest pain), echocardiography data, and complications were extracted from documents. Baseline characteristics and outcomes were compared between the 2 groups.
Results: All baseline characteristics were comparable between the 2 groups, except age (P=0.029), renal failure (P=0.018), and the left ventricular ejection fraction (P=0.011), which were higher in the cryoballoon group. The overall complication rate was higher in the RF group (P=0.021), but the 2 groups were comparable concerning each complication. Recurrence within less than 1 month was higher in the cryoballoon group (P=0.002).
Conclusions: Both RF and cryoballoon methods have their advantages and disadvantages. A historical cohort study to compare the outcomes between these 2 methods is not the proper choice in that it fails to determine which procedure confers a better outcome. A prospective survey seems more suitable for this evaluation. (Iranian Heart Journal 2022; 23(3): 59-63)


  1. Camm AJ, Obel OA. Epidemiology and mechanism of atrial fibrillation and atrial flutter. Am J Cardiol. 1996;
  2. Benjamin EJ, Wolf PA, D’Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: The Framingham Heart Study. Circulation. 1998;
  3. Wolf PA, Mitchell JB, Baker CS, Kannel WB, D’Agostino RB. Impact of atrial fibrillation on mortality, stroke, and medical costs. Arch Intern Med. 1998;
  4. Connolly SJ. Preventing stroke in atrial fibrillation: Why are so many eligible patients not receiving anticoagulant therapy? CMAJ. 1999.
  5. Haïssaguerre M, Jaïs P, Shah DC, Takahashi A, Hocini M, Quiniou G, et al. Spontaneous Initiation of Atrial Fibrillation by Ectopic Beats Originating in the Pulmonary Veins. N Engl J Med. 1998;
  6. Chen SA, Hsieh MH, Tai CT, Tsai CF, Prakash VS, Yu WC, et al. Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins: Electrophysiological characteristics, pharmacological responses, and effects of radiofrequency ablation. Circulation. 1999;
  7. Wilber DJ, Pappone C, Neuzil P, De Paola A, Marchlinski F, Natale A, et al. Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: A randomized controlled trial. JAMA - J Am Med Assoc. 2010;303(4):333–40.
  8. Pappone C, Vicedomini G, Augello G, Manguso F, Saviano M, Baldi M, et al. Radiofrequency catheter ablation and antiarrhythmic drug therapy: A prospective, randomized, 4-year follow-up trial: The APAF study. Circulation: Arrhythmia and Electrophysiology. 2011.
  9. Rodriguez LM, Leunissen J, Hoekstra A, Korteling BJ, Smeets JLRM, Timmermans C, et al. Transvenous cold mapping and cryoablation of the AV node in dogs: Observations of chronic lesions and comparison to those obtained using radiofrequency ablation. J Cardiovasc Electrophysiol. 1998;
  10. Providencia R, Defaye P, Lambiase PD, Pavin D, Cebron JP, Halimi F, et al. Results from a multicentre comparison of cryoballoon vs. radiofrequency ablation for paroxysmal atrial fibrillation: Is cryoablation more reproducible? Europace. 2017;19(1):48–57.
  11. Neumann T, Vogt J, Schumacher B, Dorszewski A, Kuniss M, Neuser H, et al. Circumferential Pulmonary Vein Isolation With the Cryoballoon Technique. Results From a Prospective 3-Center Study. J Am Coll Cardiol. 2008;
  12. Markides V, Schilling RJ. Atrial fibrillation: classification, pathophysiology, mechanisms and drug treatment * 939. 2003;