Cryoballoon pulmonary vein isolation versus radiofrequency ablation of the pulmonary veins and left atrial posterior wall: Patient‐reported outcomes

Background Data are lacking on patient‐reported outcomes (PRO) following cryoballoon ablation (CBA) versus radiofrequency ablation (RFA). We sought to evaluate QoL and clinical outcomes of cryoballoon pulmonary vein isolation only (CRYO‐PVI‐ONLY) versus RFA with PVI and posterior wall isolation (RF‐PVI+PWI) in a large prospective PRO registry. Methods Patients who underwent AF ablation (2013–2016) at our institution were enrolled in an automated, prospectively maintained PRO registry. CRYO‐PVI‐ONLY patients were matched (1:1) with RF‐PVI+PWI patients based on age, gender, and type of AF (paroxysmal vs. persistent). QoL and clinical outcomes were assessed using PRO surveys at baseline and at 1‐year. The atrial fibrillation symptom severity scale (AFSSS) was the measure for QoL. Additionally, we assessed patient‐reported clinical improvement, arrhythmia recurrence, and AF burden (as indicated by AF frequency and duration scores). Results A total of 296 patients were included (148 in each group, 72% paroxysmal). By PRO, a significant improvement in QoL was observed in the overall study population and was comparable between CRYO‐PVI‐ONLY and RF‐PVI+PWI (baseline median AFSSS of 11.5 and 11; reduced to 2 and 4 at 1 year, respectively; p = 0.44). Similarly, the proportion of patients who reported improvement in their overall QoL and AF related symptoms was high and similar between the study groups [92% (CRYO‐PVI‐ONLY) vs. 92.8% (RF‐PVI+PWI); p = 0.88]. Arrhythmia recurrence was significantly more common in the CRYO‐PVI‐ONLY group (39.7%) compared to RF‐PVI+PWI (27.7 %); p = 0.03. Comparable results were observed in paroxysmal and persistent AF. Conclusion CRYO‐PVI‐ONLY and RF‐PVI+PWI resulted in comparable improvements in patient reported outcomes including QoL and AF burden; with RF‐PVI+PWI being more effective at reducing recurrences.