CRYOBALLOON ablation has demonstrated similar effectiveness and safety compared to radiofrequency ablation in treating patients with persistent atrial fibrillation, according to the results of the CRRF-PeAF trial, a major multicentre randomised study.
The CRRF-PeAF trial recruited 500 adults diagnosed with persistent atrial fibrillation from 12 centres and randomly assigned them to treatment with either cryoballoon or radiofrequency ablation. The median patient age was 69 years. The trial’s primary outcome was the occurrence of atrial tachyarrhythmias within one year following ablation, excluding a 90-day post-procedure “blanking period.” In the final analysis, 499 patients were included: 249 in the cryoballoon group and 250 in the radiofrequency group. The results showed that atrial tachyarrhythmias occurred in 22.5 per cent of patients who underwent cryoballoon ablation and in 23.2 per cent of those treated with radiofrequency ablation. Statistical comparison proved non-inferiority for the cryoballoon technique (hazard ratio 0.99; 95 per cent confidence interval, 0.69 to 1.43; P = 0.96). While both treatments were effective in stabilising heart rhythm, a notable difference was observed in left atrial volume: radiofrequency ablation led to a greater reduction at one year compared to cryoballoon ablation.
This study confirms that cryoballoon ablation offers an alternative to radiofrequency ablation for managing persistent atrial fibrillation, with similar rates of arrhythmia recurrence and safety outcomes at one year. In clinical practice, the choice between these ablation techniques can be tailored according to patient needs, operator experience, and equipment availability without compromising efficacy. The difference in left atrial remodelling may warrant further research to understand its implications for longer-term heart function and patient outcomes. Ongoing evaluation of both techniques will be important, but clinicians can now be confident offering cryoballoon ablation as an effective option for patients with persistent atrial fibrillation.
Reference
Miyamoto K et al. Cryoballoon vs radiofrequency ablation in persistent atrial fibrillation: the CRRF-PeAF trial. European Heart Journal. 2025;ehaf451.
