Comparison of efficacy and safety of laser balloon and cryoballoon ablation for atrial fibrillation-a meta-analysis.

BACKGROUND: Laser balloon (LB) and cryoballoon (CB) ablation are two balloon-based catheter ablation technologies used for atrial fibrillation (AF) ablation in recent years. However, the efficacy and the safety of LB ablation in comparison to CB ablation remained indeterminate. We sought to compare these two technologies by conducting meta-analysis of previous studies using both the CB and LB ablation systems for AF ablation.

METHODS: We searched electronic scientific databases for studies of LB vs. CB ablation in AF patients. The procedural efficacy was assessed by the success of acute pulmonary vein isolation (PVI) and the 12-month recurrence of any atrial arrhythmia, and the safety was evaluated by the risk of procedure-related complications.

RESULTS: A total of 595 participants (LB, n = 292 vs. CB, n = 303) from eight studies were included in this meta-analysis. Risk of acute PVI failure (risk ratio, RR 95% confidence interval [95% CI] = 2.55 [0.86-7.56], P = 0.09) and atrial arrhythmia recurrence in 12 months (RR [95% CI] = 0.91 [0.64-1.28], P = 0.59) were comparable between LB vs. CB ablation, and LB ablation tended to be more effective than CB ablation in paroxysmal AF patients (RR [95% CI] = 0.70 [0.47-1.03], P = 0.07). Risk of procedure-related complications was similar while LB ablation showed slightly higher risk without statistic significance (LB 13.9% vs. CB 9.3%, RR [95% CI] = 1.52 [0.88-2.64], P = 0.14). Compared with CB ablation, LB ablation led to longer procedure duration (weighted mean differences WMD [95% CI] =29.7 [15.8-43.7], P < 0.001) while similar fluoroscopy duration was observed between these two ablation devices (WMD [95% CI] = - 1.99[- 6.46-2.47], P = 0.38).

CONCLUSIONS: LB ablation has a trend toward higher procedural efficacy compared with CB ablation in paroxysmal AF patients. However, longer procedure duration and a statistically non-significant trend of more procedure-related complications were also observed in patients ablated by LB. Further larger comparative randomized trials are warranted to disclose the impact of LB compared with CB for ablation of AF.