Efficacy
The 79.9% recurrence rate reported here is higher than reports from recent meta-analysis of treatment success for PAF, cryoablation (28% recurrence) AADs (45% recurrence).22 Additionally, the current data are promising in light of historic studies of the effectiveness of cryoablation.1 Though it used different endpoints, FIRE and ICE reported cryoballoon effectiveness of 65%, with 87/376 pts (23%) having documented recurrence of atrial arrythmia.23 STOP AF reported a 69% overall effectiveness of cryoablation3 though that study allowed continued treatment with the same dose of previously ineffective AADs but used a first generation cryoballoon. Cryo-First reported similar outcomes to the current study, with an 82.2% freedom from recurrence of atrial arrythmia in early PAF patients with no AAD history.24 It should be noted that outcomes might be improved in patients undergoing ablation prior to trials of antiarrhythmic drugs and thus early in the course of their disease.. A recent study of a pulsed field ablation (PFA) system of 150 paroxysmal AF patients had a markedly higher rate of documented recurrence (33.8 vs the present 19.1) and more repeat ablations (8% vs the present 4.4%).25 A recent randomized controlled trial comparing PFA to thermal (Cryo and RF) ablation modalities also aids in putting this data in perspective, ADVENT reported a 73% and 71% effectiveness for PFA and thermal ablation, respectively.26 The effectiveness of thermal ablation in that trial was comparable to the present findings, though the Bayesian analysis used in ADVENT makes direct comparison to traditional KM analysis challenging. Further insights into the relative effectiveness of cryoablation and novel PFA systems may have significant impact on the landscape of AF treatment.