What does this research mean for the field?

Cryoballoon ablation achieved a higher first-pass Boxi success rate of 77.8% compared to 37% for radiofrequency ablation in patients with atrial fibrillation. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

This research examines and compares the effectiveness and safety of radiofrequency and cryoballoon ablation for left atrial box isolation in patients with atrial fibrillation.

February 8, 2026

Radiofrequency catheter versus cryoballoon ablation for left atrial box isolation in patients with atrial fibrillation: a propensity score-matched analysis

Resultado clave

Box isolation with radiofrequency and cryoballoon showed similar 2-year atrial tachyarrhythmia-free survival (77.8% vs. 88.9%; P=0.42) and safety.

Puntos clave

This research examines and compares the effectiveness and safety of radiofrequency and cryoballoon ablation for left atrial box isolation in patients with atrial fibrillation.
Analyzed 131 patients with atrial fibrillation undergoing box isolation using RF or CB.
Patients were matched 1:1 based on propensity scores for comparison.
Followed participants for documented atrial tachyarrhythmia lasting over 30 seconds post-procedure.
Procedure time was shorter for cryoballoon compared to radiofrequency (237 min vs. 280 min).
First-pass box isolation success was higher in cryoballoon patients (77.8%) compared to radiofrequency (37%).
Overall complication rates were similar, with RF at 5.6% and CB at 9.3%.
Two-year arrhythmia freedom rates were comparable between RF and CB.

PICO estructurado

Does radiofrequency catheter ablation compared to cryoballoon ablation improve freedom from atrial tachyarrhythmia in patients with atrial fibrillation undergoing left atrial box isolation?

Población

131 patients with atrial fibrillation (61.1% paroxysmal), mean age 71±9 years, undergoing de novo left atrial box isolation (Boxi). 108 patients were included in a 1:1 propensity score-matched analysis.

Intervención

Contact force sensing radiofrequency catheter ablation (RF) for left atrial box isolation

Comparador

Second-generation cryoballoon ablation (CB) for left atrial box isolation

Resultado

Any documented atrial tachyarrhythmia (ATA) lasting longer than 30 seconds after a 3-month blanking periodhard clinical

Radiofrequency and cryoballoon ablation for left atrial box isolation in atrial fibrillation demonstrate similar 2-year arrhythmia-free survival and safety profiles.

Resultado numérico

Tasa de eventos absoluta: 0% vs 0%

Resumen

Abstract Background Box isolation (Boxi), achieving posterior wall isolation (PWI) of the left atrium (LA) adjunct to pulmonary vein isolation (PVI), either using contact force sensing radiofrequency catheter ablation (RF) or the second-generation cryoballoon ablation (CB) has shown favorable outcomes in patients with atrial fibrillation (AF). Purpose We sought to compare the efficacy and safety of Boxi using RF vs. CB in patients with AF. Methods A total of 131 patients with AF 80 (61.1%) paroxysmal, mean age: 71±9 years who underwent de novo Boxi RF: 68 (51.9%), CB: 63 (48.1%) were enrolled. Of them, 54 patients followed by RF were compared to propensity score-matched patients (1:1) followed by CB. Both cohorts were followed for any documented atrial tachyarrhythmia (ATA) lasting longer than 30 s after a 3-month blanking period. Results Procedure time was significantly shorter, whereas fluoroscopy time was significantly longer in patients who underwent CB as compared with those who underwent RF CB vs. RF: 237±42 vs. 280±68 min.(P=0.012), and 72±25 vs. 49±17 min.(P=0.034). The proportion of first-pass Boxi were 37% of overall patients with RF, and 77.8% with CB (P0.001). Overall complication rates were 5.6% with RF and 9.3% with CB (P=0.46). The 2-year Kaplan-Meier estimated free-survival rate of ATA were comparable between the patients who underwent RF and CB (RF vs. CB: 77.8% vs. 88.9%; Log-rank P=0.42). Conclusion Boxi completion with RF and CB were feasible and safe, with similar arrhythmia freedom at 2-year follow-up.

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