Impact of radiofrequency versus cryoballoon ablation on left atrial calcification after atrial fibrillation ablation: A propensity score-matched comparison.

INTRODUCTION

Left atrial calcification (LAC) following atrial fibrillation (AF) ablation is associated with major adverse cardiovascular events, with prior reports focusing on radiofrequency catheter ablation (RFCA) rather than cryoballoon ablation (CBA). The aim of this study was to investigate the frequency of LAC and stiff LA physiology (SLAP) in patients undergoing CBA as the initial therapy for AF, compared with those undergoing RFCA, using a propensity score-matched (PSM) population.

METHODS

We conducted a retrospective cohort study involving 2680 consecutive patients who underwent AF ablation with RFCA or CBA. Patients with rheumatic valve disease or mitral valve replacement, those undergoing dialysis, and those without postoperative computed tomography (CT) imaging were excluded. CT images acquired ≥1 year after the initial procedure were used to evaluate the LAC.

RESULTS

In total, 473 eligible patients were identified. PSM created 125 pairs. After a median follow-up of 4.7 years, 9 (4 %) of 250 patients presented with LAC. Those who underwent CBA had a significantly lower incidence of LAC and SLAP compared to those who underwent RFCA (LAC: 1 % vs. 6 %, P = 0.03; SLAP: 1 % vs. 9 %, P = 0.005). Right ventricular systolic pressure significantly increased in the RFCA group (pre-ablation: 23 ± 8 vs. post-ablation: 26 ± 8, P = 0.01), but remained unchanged in the CBA group (pre-ablation: 23 ± 7 vs. post-ablation: 23 ± 8, P = 0.88).

CONCLUSIONS

The use of CBA as the initial ablation seems to have clinical benefits in preventing LAC and SLAP compared to RFCA.