Real-World Outcomes of Cryoballoon vs. Radiofrequency Ablation in Atrial Fibrillation: A Multicenter Propensity-Matched Analysis of Short- and Long-term Efficacy
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND AND OBJECTIVES: Thermal energy-based catheter ablation techniques, including cryoballoon ablation (CBA) and radiofrequency ablation (RFA), are widely utilized for rhythm control in patients with atrial fibrillation. However, direct comparisons of CBA and RFA using real-world data are limited. This study aims to evaluate the short- and long-term outcomes of CBA and RFA. METHODS: A total of 4,868 patients who underwent procedures between January 2018 and July 2022 were selected from the Korean CBA Registry and a multicenter RFA cohort. The primary outcome was the atrial tachyarrhythmia recurrence. To reduce selection bias, 1:1 propensity score matching (PSM) was performed, yielding 1,843 patients in each group. RESULTS: After PSM, RFA demonstrated significantly lower recurrence rates compared with CBA at both 1 year (20.9% vs. 27.9%; hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.61-0.79) and 3 years (31.9% vs. 35.2%; HR, 0.72; 95% CI, 0.65-0.81). In multivariable Cox regression analysis, RFA was independently associated with lower recurrence risk, with a 30% relative risk reduction at 1 year (HR, 0.70; 95% CI, 0.61-0.80) and a 27% relative risk reduction at 3 years (HR, 0.73; 95% CI, 0.65-0.81). When cavotricuspid isthmus (CTI) ablation was performed in addition to pulmonary vein isolation (PVI), recurrence rates were comparable between RFA and CBA. CONCLUSIONS: In this large, multicenter real-world cohort, RFA consistently demonstrated more favorable short- and long-term outcomes than CBA, even after PSM and multivariable adjustment. However, outcomes were comparable when CTI ablation was additionally performed, underscoring the importance of procedural strategies beyond PVI.
Source: Korean Circulation Journal
Authors: Yeji Kim, Joo Hee Jeong, Hong Euy Lim, Il-Young Oh, Myung-Jin Cha, So-Ryoung Lee, Ju Youn Kim, Chang Hee Kwon, Sung Ho Lee, Ki-Hun Kim, Pil-Sung Yang, Jun Hyung Kim, Seung-Young Roh, Junbeom Park, Dong-Hyeok Kim, Jaemin Shim
Institutions: Ewha Womans University, Ewha Womans University Seoul Hospital, Korea University Anam Hospital, Chung-Ang University Gwangmyeong Hospital, Seoul National University, Seoul National University Bundang Hospital, Asan Medical Center, University of Ulsan, Seoul National University Hospital, Kangbuk Samsung Hospital, Sungkyunkwan University, Chungnam National University, Samsung Medical Center, Chungnam National University Hospital, Konkuk University, Konkuk University Medical Center, Inje University, Inje University Haeundae Paik Hospital, CHA University Bundang Medical Center, CHA University, Korea University Guro Hospital
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7153717664