Indirect comparison of cryoablation and radiofrequency ablation as initial therapy for symptomatic paroxysmal atrial fibrillation: A systematic review and network meta-analysis of randomized controlled trials

Introduction: Data on first-line ablation treatment for patients with symptomatic atrial fibrillation (AF) are scarce. This study indirectly compared the efficacy and safety of cryoballoon ablation (CBA) vs. radiofrequency ablation (RFA) as initial therapy for symptomatic AF. Methods: We searched the EMBASE, PubMed, Cochrane Library, and ClinicalTrials.gov databases for randomized controlled trials (RCTs) that compared CBA or RFA with antiarrhythmic drugs (AADs) as first-line treatment for AF from the time of database establishment up to December 2021. The odds ratio (OR) with a 95% confidence interval (CI) was used as a measure of the treatment effect. Results: Six RCTs (3 CBA, 3 RFA) that enrolled a total of 1215 patients were included in this analysis. There were no significant differences in atrial arrhythmia (AA) (OR 0.993, 95% CI 0.602–1.638), symptomatic AA (OR 0.638, 95% CI 0.344–1.182), or serious adverse events (OR 1.474, 95% CI, 0.404–5.376) between the two ablation techniques. The incidences of additional CBA therapy (OR 2.693, 95% CI 1.277–5.681) and patients who crossed over to AAD therapy (OR 0.345 95% CI 0.179–0.664) in the CBA group were significantly lower than that in the RFA group. Conclusion: Among patients with paroxysmal AF receiving initial therapy, CBA and RFA share a similar efficacy and safety profile. When pulmonary vein isolation is performed by CBA, study crossover and the need for additional ablation are substantially lower.