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July 5, 2026Pacing and Clinical ElectrophysiologyOpen Access

Cryoballoon ablation matches radiofrequency ablation for 12-month freedom from any atrial arrhythmia in persistent AF.

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Why the study?

Does cryoballoon ablation improve 12-month freedom from any atrial arrhythmia compared to radiofrequency ablation in patients with persistent atrial fibrillation?

Population

5 RCTs enrolling 1,091 patients (515 CBA, 576 RFA) with persistent atrial fibrillation (PeAF)

Comparison

Cryoballoon ablation (CBA) vs Radiofrequency ablation (RFA)

Design

Meta-analysis

Follow-up

12 months

Key result

Cryoballoon ablation achieved equivalent 12-month freedom from any atrial arrhythmia compared to radiofrequency ablation in persistent atrial fibrillation (RR 0.97; 95% CI 0.81-1.15; p=0.71).

Authors

HBHarroop BolaAAAksaan ArifJHJoshua J Hon

Discussion

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Overview

CBA matches RFA for 12-month arrhythmia freedom in PeAF while shortening procedures; confirms equivalence and supports CBA for workflow efficiency.

Key Points

  • This study aims to compare the efficacy and safety of cryoballoon ablation (CBA) and radiofrequency ablation (RFA) in treating persistent atrial fibrillation (PeAF).
  • Systematic review of 5 randomized controlled trials (RCTs) involving 1,091 patients (515 CBA, 576 RFA).
  • Primary endpoint was 12-month freedom from any atrial arrhythmia; time-to-event data analyzed using hazard ratios (HR).
  • Meta-analysis utilized random-effects models for risk and mean difference assessment.
  • CBA and RFA show equivalent freedom from any arrhythmia (RR 0.97, 95% CI 0.81–1.15; p = 0.71).
  • CBA significantly reduced procedural time by an average of 45.37 minutes (p < 0.0001).
  • Major complications rates were comparable (1.5% CBA vs. 2.7% RFA; p = 0.18).

Study Design

Type

Meta-Analysis (n=1,091)

Structured PICO

Does cryoballoon ablation improve 12-month freedom from any atrial arrhythmia compared to radiofrequency ablation in patients with persistent atrial fibrillation?

P
Population
1,091 patients with persistent atrial fibrillation from 5 randomized controlled trials followed for 12 months.
I
Intervention
Cryoballoon ablation (CBA)
C
Comparator
Radiofrequency ablation (RFA)
O
Outcome
12-month freedom from any atrial arrhythmiacomposite

Main Result

Relative Risk: 0.97 (95% CI 0.81–1.15)

p-value: p=0.71

In patients with persistent atrial fibrillation, cryoballoon ablation and radiofrequency ablation achieve equivalent 12-month arrhythmia-free survival, but cryoballoon ablation significantly reduces procedural time.

Limitations

  • Reliance on 12-month follow-up
  • Heterogeneous rhythm surveillance protocols may limit assessments of true long-term durability
  • reliance on 12-month follow-up
  • heterogeneous rhythm surveillance protocols

Cite This Study

Bola et al. (2026) conducted a meta-analysis in Persistent atrial fibrillation (n=1,091). Cryoballoon ablation vs. Radiofrequency ablation was evaluated on 12-month freedom from any atrial arrhythmia (RR 0.97, 95% CI 0.81-1.15, p=0.71). Cryoballoon ablation achieved equivalent 12-month freedom from any atrial arrhythmia compared to radiofrequency ablation in persistent atrial fibrillation (RR 0.97; 95% CI 0.81-1.15; p=0.71).

synapsesocial.com/papers/6a49f411f5d1d45b287ffd5ehttps://doi.org/10.1111/pace.70350
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Pulsed field <i>vs</i> cryoballoon ablation: A meta-analysis with Hartung–Knapp, subgroup, and meta-regression analyses2025
  2. 2Pulsed field ablation versus cryoballoon ablation for pulmonary vein isolation in atrial fibrillation: a systematic review and meta-analysis with subgroup analyses by AF type2026
  3. 3Comparative analysis of three-year efficacy of catheter ablation of atrial fibrillation using the Ablation Index module and the second-generation cryoballoon2025
  4. 4Cryoballoon versus radiofrequency ablation for persistent atrial fibrillation: an updated systematic review and meta‑analysis2025 · 4 citations
  5. 5Higher premature atrial contraction burden after radiofrequency ablation vs. pulsed field or cryoballoon ablation in paroxysmal atrial fibrillation: a 3-year follow-up retrospective study2025 · 1 citations