Korean J Thorac Cardiovasc Surg 2018; 51(4): 266-272  https://doi.org/10.5090/kjtcs.2018.51.4.266
Comparison of Radiofrequency Ablation and Cryoablation for the Recovery of Atrial Contractility and Survival
Kang Min Kim, M.D., Suryeun Chung, M.D., Sang Yoon Kim, M.D., Dong Jung Kim, M.D., Jun Sung Kim, M.D., Cheong Lim, M.D., Ph.D., Kay-Hyun Park, M.D., Ph.D.
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine
Corresponding author: Cheong Lim, Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea
(Tel) 82-31-787-7139 (Fax) 82-31-787-4050 (E-mail) mluemoon@snubh.org
Received: August 24, 2017; Revised: February 18, 2018; Accepted: February 28, 2018.; Published online: August 5, 2018.
© The Korean Journal of Thoracic and Cardiovascular Surgery. All rights reserved.

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Abstract
Background: Limited comparative data are available on the efficacy of cryoablation versus radiofrequency ablation in patients with atrial fibrillation. This study aimed to compare radiofrequency ablation and cryoablation with regard to clinical outcomes and the restoration of sinus rhythm or atrial contractility.
Methods: A total of 239 patients who underwent surgical ablation between August 2003 and December 2016 at our institution were included. The patients were divided into 2 groups according to the energy device that was used (group A: n=140, radiofrequency ablator; group B: n=99, cryoablator). Echocardiographic data, overall survival, and major cardiovascular and cerebrovascular event (MACCE)-free survival were compared between the 2 groups.
Results: At 1 year of follow-up, the atrial contractility recovery rate was 32.2% (19 of 59) in group A and 48.8% (21 of 44) in group B. In addition, cryoablation was found to be a predictive factor for the recovery of atrial contractility (cryoablation vs. radiofrequency ablation: odds ratio, 2.540; 95% confidence interval, 1.063–6.071; p=0.036). The left ventricular ejection fraction was significantly higher in group B (53.1%±11.5% vs. 59.1%±6.3%, p=0.001). The median follow-up duration was 36 months. The 5-year overall survival rate was 80.1%±3.6% in group A and 92.1%±2.9% in group B (p=0.400). The 5-year MACCE-free survival rate was 70.3%±4.0% in group A and 70.9%±5.6% in group B (p=0.818).
Conclusion: Cryoablation was associated with a higher atrial contractility restoration rate and better left ventricular function than radiofrequency ablation. However, no significant relationship was observed between the energy source and overall or MACCE-free survival.
Keywords: Cox-maze procedure, Atrial contraction, Radiofrequency, Ablation, Cryoablation


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