Radiofrequency Versus Cryoballoon Catheter Ablation for Paroxysmal Atrial Fibrillation: Durability of Pulmonary Vein Isolation and Effect on Atrial Fibrillation Burden: The RACE-AF Randomized Controlled Trial

Samuel K Sørensen, Arne Johannessen, René Worck, Morten L Hansen, Jim Hansen, Samuel K Sørensen, Arne Johannessen, René Worck, Morten L Hansen, Jim Hansen

Abstract

[Figure: see text].

Trial registration: ClinicalTrials.gov NCT03805555.

Keywords: atrial fibrillation; catheter ablation; cryosurgery; electrocardiography, ambulatory; pulmonary vein; radiofrequency ablation; recurrence; second-look surgery.

Figures

Figure 1.
Figure 1.
Randomization and patient (pt) flow in the RACE-AF trial. (Radiofrequency versus Cryoballoon Catheter Ablation for Paroxysmal Atrial Fibrillation - Durability of Pulmonary Vein Isolation and Effect on Atrial Fibrillation Burden) *Before pulmonary vein isolation (PVI), the diagnosis of atrial fibrillation was rejected in 2 pts. One did not have symptomatic arrhythmia; the other had ectopic atrial tachycardia. †Protocol was breached as the ablation method was switched from cryoballoon catheter ablation (CRYO) to radiofrequency catheter ablation (RF) to isolate the remaining 3 pulmonary veins in spite of a persistent phrenic nerve palsy. ICM indicates implantable cardiac monitor.
Figure 2.
Figure 2.
Durability of pulmonary vein isolation after radiofrequency (RF) and cryoballoon (CRYO) ablation.Top, Columns illustrate the number of pulmonary veins in total (left columns), with acute isolation achieved at the index procedures (middle columns) and with durable isolation found at the reassessment procedures (right columns). Bottom, Columns illustrate the number of durably isolated pulmonary veins per patient. In patients with pulmonary vein reconnection, the number of durably isolated pulmonary veins was similar for both treatment groups (P=0.31). NS indicates nonsignificant.
Figure 3.
Figure 3.
Atrial fibrillation (AF) burden before and after pulmonary vein isolation (PVI). The line chart illustrates the individual patient’s AF burden before and after PVI (excluding a 3 mo blanking period). Radiofrequency catheter ablation (RF)-patients are shown in red and cryoballoon catheter ablation (CRYO)-patients are shown in blue. The box plots represent the 10th and 90th percentiles (whiskers), the 25th and 75th percentiles (boxes), and the medians (lines inside the boxes). AF burden indicates % of time in AF; and NS, nonsignificant.
Figure 4.
Figure 4.
Pulmonary vein isolation (PVI) status and atrial fibrillation (AF) recurrence. Pie charts illustrate the percentage of patients with AF recurrence according to PVI status. AF recurrence rate was significantly associated with the number of durably isolated pulmonary veins (P<0.01).

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