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To burn or to freeze: a burning question yet to be resolved.

This editorial refers to ‘Cryoballoon or radiofrequency ablation for symptomatic paroxysmal atrial fibrillation: reintervention, rehospitalization, and quality-of-life outcomes in the FIRE AND ICE trial’, by K.H. Kuck et al. doi: 10.1093/eurheartj/ehw285. 

Recently, the FIRE AND ICE Trial comparing cryoballoon ablation and radiofrequency catheter ablation (RFCA) in patients with symptomatic, drug-refractory paroxysmal atrial fibrillation (AF) was reported.1 This was a randomized controlled non-inferiority trial with the primacy efficacy endpoint of time to first documented recurrent AF or atrial tachycardia (AT), prescription of antiarrhythmic drugs (AADs), or repeat ablation after a 90-day blanking period.2 After a mean follow-up of 1.5 years, non-inferiority of cryoballoon ablation was confirmed; the two treatments did not differ with respect to either efficacy or overall safety (a composite of all-cause death, all-cause cerebrovascular events, and serious treatment-related adverse events).1 In the current issue of the journal, the authors publish some of the secondary endpoints from the FIRE AND ICE trial,3 namely all-cause and cardiovascular rehospitalizations, repeat ablations, direct current cardioversions, and quality of life. These are indeed important endpoints to report, …