Cryoballoon ablation compared with single ring radiofrequency ablation for the treatment of atrial fibrillation: The Hot and Cold Study

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Atrial fibrillation (AF) is the most common heart rhythm disorder and develops in 20-25% of people over their lifetime. The initial treatment has been medication therapy, however in the past decade, a catheter ablation procedure called pulmonary vein isolation has become increasingly widely practiced and is more effective than medical therapy at treating AF. This is performed by introducing catheters via the groin veins to the heart. There are two methods available in Australia for performing this procedure which aims to electrically isolate the pulmonary veins from the rest of the left atrium to which they connect in the heart as these usually contain abnormal foci that trigger the initiation of AF. The first of the two methods utilises radiofrequency ablation to create burns to the inside of the left atrium to encircle the pulmonary veins and the back wall of the left atrium. From a recent randomised clinical trial, we have found that the use of a large single ring was better than the conventional two separate rings in preventing the recurrence of AF. The second method uses more recent technology and involves a cryoballoon catheter that freezes the tissues around the pulmonary veins to achieve the same effect. Recent studies of this technique has shown it to be a safe and effective means of performing pulmonary vein isolation. It is not known which of the two procedures is more effective. We aim in the present randomised controlled clinical trial to investigate the relative efficacy and safety of the two procedures.

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