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Comparing Safety and Efficacy of Irrigated Radiofrequency Catheter Ablation Versus Combined Cryoballoon and Catheter Ablation for Persistent Atrial Fibrillation.

Background: Catheter and cryoballoon ablation are established treatments for atrial fibrillation. Frequently, substrate modification of the left atrium is performed in patients with persistent AF or evidence of left atrial adverse remodeling. We compared one year outcomes of AF ablation with substrate modification utilizing radiofrequency catheter ablation (RFA) compared to a combination of cryoballoon ablation with radiofrequency catheter ablation (HAFA). Methods: Ablation for persistent AF was performed using stand-alone catheter ablation (RFA group, n=31) or cryoballoon for pulmonary vein isolation with RFA catheter ablation for substrate modification (HAFA group, n=21) and procedural and clinical outcomes were analyzed. Pulmonary vein isolation and LA substrate modification including creation of left atrial ablation lines and/or CFAEs was performed in all patients. Patients were followed for up to one year. A three- month blinding window was applied for analysis. Results: Clinical characteristics were similar between groups. Total procedure (244.15±64.7 vs 235.5±54.6, p=0.6) and fluoroscopy time (37±15.4 vs 29.5±15.7, p=0.96) were not different between the HAFA and RFA groups, respectively. Periprocedural complications were similar among groups. AF free survival was not significantly different between Conclusions: Combined cryoballoon and catheter ablation for LA substrate modification (HAFA) has similar safety and efficacy compared to stand-alone catheter ablation for persistent AF. Recurrent atrial flutter is more frequently observed after cryoballoon ablation for persistent AF.