Hot or cold? Feasibility, safety, and outcome after radiofrequency‐guided versus cryoballoon‐guided left atrial appendage isolation

BACKGROUND: Left atrial appendage (LAA) isolation (LAAI) has been described as an adjunctive ablation strategy for patients with recurrent atrial tachyarrhythmia (ATa). OBJECTIVES: We compared the clinical impact of persistent durable LAAI between radiofrequency (RF)‐guided wide‐area LAAI and cryoballoon (CB)‐guided ostial LAAI. METHODS: Consecutive patients who underwent RF‐ or CB‐guided LAAI were retrospectively analyzed. RF‐guided LAAI was performed by combining linear ablation. CB‐guided LAAI was performed by LAA ostial ablation. Following LAAI, the patients underwent an invasive remapping study. LAA closure was conducted if persistent durability was confirmed. The procedural data, LAAI durability, and ATa recurrence were assessed. RESULTS: A total of 260 patients (RF: n = 201; CB: n = 59) undergoing LAAI were identified. The acute rate of procedural LAAI was higher in the CB group (CB:94.9% vs. RF:82.6%, p = .02) with a lower pericardial effusion incidence (CB:0% vs. RF:7.5%, p = .03). The 6‐week durable LAAI was similar between the two groups (RF:78.3% vs. CB:66.0%, p = .103). During follow‐up, one gastrointestinal bleeding and four stroke events including one subsequent intracranial bleeding leading to death occurred in the RF group, while one gastrointestinal bleeding occurred in the CB group. The 1‐year ATa recurrence‐free rate was higher in patients with durable LAAI following RF‐guided LAAI (RF:76.3% vs. CB:56.7%, p = .0017). Multivariate analysis revealed RF‐guided LAAI as a predictor of freedom from ATa recurrence (HR: 0.478, 95%CI: 0.336–0.823, p = .017). CONCLUSIONS: LAAI can be more readily and safely achieved by CB‐guided ostial ablation. In patients with confirmed LAAI, however, the freedom from ATa recurrence was higher after RF‐guided wide‐area isolation.