Comparison of quality-of-life following cryoballoon versus radiofrequency catheter ablation of symptomatic atrial fibrillation - a subanalysis of the FREEZE cohort study
Authors: Straube F , Dorwarth U , Pongratz J , Riess L , Kuniss M , Tebbenjohanns J , Noelker G , Tilz R , Chun J , Stellbrink C , Metzner A , Brachmann J , Kuck K H , Senges J , Hoffmann E 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Catheter ablation of symptomatic atrial fibrillation (AF) is an established treatment option. Cryoballoon (CBA) and radiofrequency ablation (RFA) have demonstrated comparable high rates of freedom from atrial arrhythmia recurrence. Comparative data on quality of life (QoL) outcomes with respect to the used energy source are scarce.

Purpose
To compare QoL changes following CBA versus RFA in symptomatic AF.

Methods
This is a sub-analysis of the prospective multi-center FREEZE Cohort Study (ClinicalTrials.gov, NCT01360008). QoL changes were assessed by EQ-5D-3L self-report questionnaire and by EHRA symptom score at baseline and follow-up. Five dimensions of QoL were compared between the treatment groups: "mobility", "self-care", "usual activities", "pain/discomfort", and "anxiety/depression". Changes of Visual Analogue Scale (EQ-VAS) and general physical condition (GPC) were assessed.

Results
From 2011 to 2016, a total of N=4,189 patients were included, and N=2,110 (50.4%) - CBA N=1,590 (75%) and RFA N=529 (25%) - completed all QoL questionnaires. Differences between groups were observed. Mean age was 61.4±10.4 (CBA) and 63.2±10.4 (RFA) years (p&lt;0.001), and 72.8%, and 65.4% of patients demonstrated paroxysmal AF (p&lt;0.01), respectively. EHRA symptom score was &gt;/= II in 89.7% versus 92.9% of patients in CBA and RFA group at baseline (p&lt;0.0001). The median follow-up duration was 422 (CBA) and 482 days (RFA), p&lt;0.0001.
At follow-up, atrial arrhythmia recurrence was documented in 45.0% and 56.9% of patients in the CBA and RFA group (p&lt;0.0001), and EHRA Score &gt;/= II was documented in 23.7% and 32.0% of patients (p&lt;0.001), respectively. Repeat ablation was less frequently performed in the CBA group (7.9% vs. 22.3%, p&lt;0.001). Ablation was rated as „overall successful" by 69.5% and 53.7% of the patients in in the CBA and RFA group, respectively (p&lt;0.0001).
Significant differences in QoL dimensions from baseline to follow-up were observed between the groups (see Figure): Patients in the CBA group showed a statistically significant greater improvement for the QoL dimension "pain/discomfort", „general physical condition", EQ-VAS, and EQ-5D-Score as compared to the RFA group (all p&lt;0.001). No differences between the groups were found for the dimensions "mobility", "self-care", "usual activities", and "anxiety/depression".

Conclusion
Catheter ablation in symptomatic AF was associated with a significant improvement of AF symptoms, "pain/discomfort", "anxiety/depression", and GPC in both groups. However, there was only a small benefit of ablation on „mobility", „self-care", and „usual activities". Interestingly, in the CBA group patients reported significantly more frequently amelioration of "pain/discomfort" and „general physical condition". This finding was confirmed by a higher EQ-VAS and EQ-5D-Score as well as a higher level of satisfaction in the CBA group, and might be related to the lower recurrence rate.