Cryoballoon Versus Radiofrequency Ablation In Persistent Atrial Fibrillation: Current Evidence And Predictors Of Recurrence
Keywords:
Atrial fibrillation; cryoballoon ablation; radiofrequency ablation; persistent AF; predictors of recurrence; electrophysiology; catheter ablation; outcomes.Abstract
Background: Persistent atrial fibrillation (AF) remains one of the most challenging arrhythmia subtypes to treat effectively. Catheter ablation has evolved as a cornerstone of rhythm-control therapy, with radiofrequency ablation (RFA) and cryoballoon ablation (CBA) being the two most widely adopted energy sources. Although both modalities aim to achieve durable pulmonary vein isolation (PVI), their relative efficacy, procedural performance, and predictors of recurrence in persistent AF continue to be debated.
Objective: To summarize and critically appraise the current evidence comparing CBA and RFA in persistent AF, emphasizing procedural characteristics, clinical outcomes, and independent predictors of arrhythmia recurrence.
Methods: A comprehensive review of randomized trials, observational studies, and meta-analyses published between 2010 and 2025 was performed, focusing on comparative outcomes between CBA and RFA in persistent AF.
Results: Both modalities achieve comparable arrhythmia-free survival at 12 months. CBA consistently demonstrates shorter procedure times and a simpler workflow but greater fluoroscopy exposure and contrast use. Predictors of recurrence include long-standing AF (>12 months), early recurrence during the blanking period, and markers of left atrial remodeling.
Conclusions: CBA and RFA provide equivalent efficacy for rhythm control in persistent AF. Early ablation, attention to atrial substrate, and close rhythm monitoring during the blanking period are key determinants of durable success. Emerging technologies such as pulsed-field ablation and imaging-guided substrate assessment may refine future strategies.
