Effectiveness and safety of a single freeze strategy of cryoballoon ablation of atrial fibrillation: an EHRA systematic review and meta-analysis
Abstract To conduct a systematic review and meta-analysis to compare the effectiveness and safety of cryoballoon ablation of atrial fibrillation (AF) performed using a single freeze strategy in comparison to an empiric double (‘bonus’) freeze strategy. We systematically searched MEDLINE, EMBASE, and...
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| Veröffentlicht in: | Europace (London, England) England), 2022-01, Vol.24 (1), p.58-69 |
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| creator | Farkowski, Michal Miroslaw Karlinski, Michal Barra, Sergio Providencia, Rui Golicki, Dominik Pytkowski, Mariusz Anic, Ante Chun, Julian Kyoung Ryul de Asmundis, Carlo Lane, Deirdre Anne Boveda, Serge |
| description | Abstract
To conduct a systematic review and meta-analysis to compare the effectiveness and safety of cryoballoon ablation of atrial fibrillation (AF) performed using a single freeze strategy in comparison to an empiric double (‘bonus’) freeze strategy. We systematically searched MEDLINE, EMBASE, and CENTRAL databases from inception to 12 July 2020, for prospective and retrospective studies of patients undergoing cryoballoon for paroxysmal or persistent AF comparing a single vs. bonus freeze strategy. The main outcome was atrial arrhythmia-free survival and eligible studies required at least 12 months of follow-up; the primary safety outcome was a composite of all complications. Study quality was assessed using the Cochrane risk of bias tool and the Newcastle–Ottawa Scale. Thirteen studies (3 randomized controlled trials and 10 observational studies) comprising 3163 patients were eligible for inclusion (64% males, 71.5% paroxysmal AF, mean CHA2DS2-VASc score 1.3 ± 0.9). There was no significant difference in pooled effectiveness between single freeze strategy compared to double freeze strategy [relative risk (RR) 1.03; 95% confidence interval (CI): 0.98–1.07; I2 = 0%]. Single freeze procedures were associated with a significantly lower adverse event rate (RR 0.72; 95% CI: 0.53–0.98; I2 = 0%) and shorter average procedure time (90 ± 27 min vs. 121 ± 36 min, P |
| doi_str_mv | 10.1093/europace/euab133 |
| format | Article |
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To conduct a systematic review and meta-analysis to compare the effectiveness and safety of cryoballoon ablation of atrial fibrillation (AF) performed using a single freeze strategy in comparison to an empiric double (‘bonus’) freeze strategy. We systematically searched MEDLINE, EMBASE, and CENTRAL databases from inception to 12 July 2020, for prospective and retrospective studies of patients undergoing cryoballoon for paroxysmal or persistent AF comparing a single vs. bonus freeze strategy. The main outcome was atrial arrhythmia-free survival and eligible studies required at least 12 months of follow-up; the primary safety outcome was a composite of all complications. Study quality was assessed using the Cochrane risk of bias tool and the Newcastle–Ottawa Scale. Thirteen studies (3 randomized controlled trials and 10 observational studies) comprising 3163 patients were eligible for inclusion (64% males, 71.5% paroxysmal AF, mean CHA2DS2-VASc score 1.3 ± 0.9). There was no significant difference in pooled effectiveness between single freeze strategy compared to double freeze strategy [relative risk (RR) 1.03; 95% confidence interval (CI): 0.98–1.07; I2 = 0%]. Single freeze procedures were associated with a significantly lower adverse event rate (RR 0.72; 95% CI: 0.53–0.98; I2 = 0%) and shorter average procedure time (90 ± 27 min vs. 121 ± 36 min, P < 0.001). A trend for lower risk of persistent phrenic nerve palsy was observed (RR 0.61; 95% CI: 0.37–1.01; I2 = 0%). The quality of included studies was moderate/good, with no evidence of significant publication bias. Single freeze strategy for cryoballoon of AF is as effective as an empiric double (‘bonus’) freeze strategy while appearing safer and probably quicker (PROSPERO registration number CRD42020158696).</description><identifier>ISSN: 1099-5129</identifier><identifier>EISSN: 1532-2092</identifier><identifier>DOI: 10.1093/europace/euab133</identifier><identifier>PMID: 34297839</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Atrial Fibrillation - diagnosis ; Atrial Fibrillation - etiology ; Atrial Fibrillation - surgery ; Catheter Ablation - adverse effects ; Cryosurgery - adverse effects ; Cryosurgery - methods ; Female ; Humans ; Male ; Prospective Studies ; Pulmonary Veins - surgery ; Randomized Controlled Trials as Topic ; Retrospective Studies ; Treatment Outcome</subject><ispartof>Europace (London, England), 2022-01, Vol.24 (1), p.58-69</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com. 2021</rights><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c443t-b761e518b50c00eb5e775c6404d1937a778123af09f045d6cf05bc4eff55f2723</citedby><cites>FETCH-LOGICAL-c443t-b761e518b50c00eb5e775c6404d1937a778123af09f045d6cf05bc4eff55f2723</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1604,27924,27925</link.rule.ids><linktorsrc>$$Uhttps://dx.doi.org/10.1093/europace/euab133$$EView_record_in_Oxford_University_Press$$FView_record_in_$$GOxford_University_Press</linktorsrc><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34297839$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Farkowski, Michal Miroslaw</creatorcontrib><creatorcontrib>Karlinski, Michal</creatorcontrib><creatorcontrib>Barra, Sergio</creatorcontrib><creatorcontrib>Providencia, Rui</creatorcontrib><creatorcontrib>Golicki, Dominik</creatorcontrib><creatorcontrib>Pytkowski, Mariusz</creatorcontrib><creatorcontrib>Anic, Ante</creatorcontrib><creatorcontrib>Chun, Julian Kyoung Ryul</creatorcontrib><creatorcontrib>de Asmundis, Carlo</creatorcontrib><creatorcontrib>Lane, Deirdre Anne</creatorcontrib><creatorcontrib>Boveda, Serge</creatorcontrib><title>Effectiveness and safety of a single freeze strategy of cryoballoon ablation of atrial fibrillation: an EHRA systematic review and meta-analysis</title><title>Europace (London, England)</title><addtitle>Europace</addtitle><description>Abstract
To conduct a systematic review and meta-analysis to compare the effectiveness and safety of cryoballoon ablation of atrial fibrillation (AF) performed using a single freeze strategy in comparison to an empiric double (‘bonus’) freeze strategy. We systematically searched MEDLINE, EMBASE, and CENTRAL databases from inception to 12 July 2020, for prospective and retrospective studies of patients undergoing cryoballoon for paroxysmal or persistent AF comparing a single vs. bonus freeze strategy. The main outcome was atrial arrhythmia-free survival and eligible studies required at least 12 months of follow-up; the primary safety outcome was a composite of all complications. Study quality was assessed using the Cochrane risk of bias tool and the Newcastle–Ottawa Scale. Thirteen studies (3 randomized controlled trials and 10 observational studies) comprising 3163 patients were eligible for inclusion (64% males, 71.5% paroxysmal AF, mean CHA2DS2-VASc score 1.3 ± 0.9). There was no significant difference in pooled effectiveness between single freeze strategy compared to double freeze strategy [relative risk (RR) 1.03; 95% confidence interval (CI): 0.98–1.07; I2 = 0%]. Single freeze procedures were associated with a significantly lower adverse event rate (RR 0.72; 95% CI: 0.53–0.98; I2 = 0%) and shorter average procedure time (90 ± 27 min vs. 121 ± 36 min, P < 0.001). A trend for lower risk of persistent phrenic nerve palsy was observed (RR 0.61; 95% CI: 0.37–1.01; I2 = 0%). The quality of included studies was moderate/good, with no evidence of significant publication bias. Single freeze strategy for cryoballoon of AF is as effective as an empiric double (‘bonus’) freeze strategy while appearing safer and probably quicker (PROSPERO registration number CRD42020158696).</description><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - etiology</subject><subject>Atrial Fibrillation - surgery</subject><subject>Catheter Ablation - adverse effects</subject><subject>Cryosurgery - adverse effects</subject><subject>Cryosurgery - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Prospective Studies</subject><subject>Pulmonary Veins - surgery</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Retrospective Studies</subject><subject>Treatment Outcome</subject><issn>1099-5129</issn><issn>1532-2092</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUctOHDEQtKKg8EjuOSEfI0VD_Biv19wQ2gQkJCQE51Hb20aOZsaL7QENX5FPjmEXrpy61F1V3eoi5DtnJ5wZ-QunFDfgsAKwXMpP5IArKRrBjPhcMTOmUVyYfXKY81_GmBZGfSH7shVGL6U5IP9W3qMr4RFHzJnCuKYZPJaZRk-B5jDe90h9QnxGmkuCgvevM5fmaKHvYxwp2B5KqOBFU1KAnvpgU-i37dNqS1cXN2c0z7ngUJuOJnwM-PS6cMACDYzQzznkr2TPQ5_x264ekbvfq9vzi-bq-s_l-dlV49pWlsbqBUfFl1YxxxhahVort2hZu-ZGatB6yYUEz4xnrVovnGfKuha9V8oLLeQR-bH13aT4MGEu3RCyw3ryiHHKnVBKcbaQXFcq21Jdijkn9N0mhQHS3HHWveTQveXQ7XKokuOd-2QHXL8L3h5fCT-3hDhtPrb7DyL1mIc</recordid><startdate>20220104</startdate><enddate>20220104</enddate><creator>Farkowski, Michal Miroslaw</creator><creator>Karlinski, Michal</creator><creator>Barra, Sergio</creator><creator>Providencia, Rui</creator><creator>Golicki, Dominik</creator><creator>Pytkowski, Mariusz</creator><creator>Anic, Ante</creator><creator>Chun, Julian Kyoung Ryul</creator><creator>de Asmundis, Carlo</creator><creator>Lane, Deirdre Anne</creator><creator>Boveda, Serge</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20220104</creationdate><title>Effectiveness and safety of a single freeze strategy of cryoballoon ablation of atrial fibrillation: an EHRA systematic review and meta-analysis</title><author>Farkowski, Michal Miroslaw ; Karlinski, Michal ; Barra, Sergio ; Providencia, Rui ; Golicki, Dominik ; Pytkowski, Mariusz ; Anic, Ante ; Chun, Julian Kyoung Ryul ; de Asmundis, Carlo ; Lane, Deirdre Anne ; Boveda, Serge</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c443t-b761e518b50c00eb5e775c6404d1937a778123af09f045d6cf05bc4eff55f2723</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - etiology</topic><topic>Atrial Fibrillation - surgery</topic><topic>Catheter Ablation - adverse effects</topic><topic>Cryosurgery - adverse effects</topic><topic>Cryosurgery - methods</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Prospective Studies</topic><topic>Pulmonary Veins - surgery</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Retrospective Studies</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Farkowski, Michal Miroslaw</creatorcontrib><creatorcontrib>Karlinski, Michal</creatorcontrib><creatorcontrib>Barra, Sergio</creatorcontrib><creatorcontrib>Providencia, Rui</creatorcontrib><creatorcontrib>Golicki, Dominik</creatorcontrib><creatorcontrib>Pytkowski, Mariusz</creatorcontrib><creatorcontrib>Anic, Ante</creatorcontrib><creatorcontrib>Chun, Julian Kyoung Ryul</creatorcontrib><creatorcontrib>de Asmundis, Carlo</creatorcontrib><creatorcontrib>Lane, Deirdre Anne</creatorcontrib><creatorcontrib>Boveda, Serge</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Europace (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Farkowski, Michal Miroslaw</au><au>Karlinski, Michal</au><au>Barra, Sergio</au><au>Providencia, Rui</au><au>Golicki, Dominik</au><au>Pytkowski, Mariusz</au><au>Anic, Ante</au><au>Chun, Julian Kyoung Ryul</au><au>de Asmundis, Carlo</au><au>Lane, Deirdre Anne</au><au>Boveda, Serge</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effectiveness and safety of a single freeze strategy of cryoballoon ablation of atrial fibrillation: an EHRA systematic review and meta-analysis</atitle><jtitle>Europace (London, England)</jtitle><addtitle>Europace</addtitle><date>2022-01-04</date><risdate>2022</risdate><volume>24</volume><issue>1</issue><spage>58</spage><epage>69</epage><pages>58-69</pages><issn>1099-5129</issn><eissn>1532-2092</eissn><abstract>Abstract
To conduct a systematic review and meta-analysis to compare the effectiveness and safety of cryoballoon ablation of atrial fibrillation (AF) performed using a single freeze strategy in comparison to an empiric double (‘bonus’) freeze strategy. We systematically searched MEDLINE, EMBASE, and CENTRAL databases from inception to 12 July 2020, for prospective and retrospective studies of patients undergoing cryoballoon for paroxysmal or persistent AF comparing a single vs. bonus freeze strategy. The main outcome was atrial arrhythmia-free survival and eligible studies required at least 12 months of follow-up; the primary safety outcome was a composite of all complications. Study quality was assessed using the Cochrane risk of bias tool and the Newcastle–Ottawa Scale. Thirteen studies (3 randomized controlled trials and 10 observational studies) comprising 3163 patients were eligible for inclusion (64% males, 71.5% paroxysmal AF, mean CHA2DS2-VASc score 1.3 ± 0.9). There was no significant difference in pooled effectiveness between single freeze strategy compared to double freeze strategy [relative risk (RR) 1.03; 95% confidence interval (CI): 0.98–1.07; I2 = 0%]. Single freeze procedures were associated with a significantly lower adverse event rate (RR 0.72; 95% CI: 0.53–0.98; I2 = 0%) and shorter average procedure time (90 ± 27 min vs. 121 ± 36 min, P < 0.001). A trend for lower risk of persistent phrenic nerve palsy was observed (RR 0.61; 95% CI: 0.37–1.01; I2 = 0%). The quality of included studies was moderate/good, with no evidence of significant publication bias. Single freeze strategy for cryoballoon of AF is as effective as an empiric double (‘bonus’) freeze strategy while appearing safer and probably quicker (PROSPERO registration number CRD42020158696).</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>34297839</pmid><doi>10.1093/europace/euab133</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Europace (London, England), 2022-01, Vol.24 (1), p.58-69 |
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| subjects | Atrial Fibrillation - diagnosis Atrial Fibrillation - etiology Atrial Fibrillation - surgery Catheter Ablation - adverse effects Cryosurgery - adverse effects Cryosurgery - methods Female Humans Male Prospective Studies Pulmonary Veins - surgery Randomized Controlled Trials as Topic Retrospective Studies Treatment Outcome |
| title | Effectiveness and safety of a single freeze strategy of cryoballoon ablation of atrial fibrillation: an EHRA systematic review and meta-analysis |
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