Cryoballoon or radiofrequency ablation for symptomatic paroxysmal atrial fibrillation : reintervention, rehospitalization, and quality-of-life outcomes in the FIRE AND ICE trial

  • Aims: The primary safety and efficacy endpoints of the randomized FIRE AND ICE trial have recently demonstrated non-inferiority of cryoballoon vs. radiofrequency current (RFC) catheter ablation in patients with drug-refractory symptomatic paroxysmal atrial fibrillation (AF). The aim of the current study was to assess outcome parameters that are important for the daily clinical management of patients using key secondary analyses. Specifically, reinterventions, rehospitalizations, and quality-of-life were examined in this randomized trial of cryoballoon vs. RFC catheter ablation. Methods and results: Patients (374 subjects in the cryoballoon group and 376 subjects in the RFC group) were evaluated in the modified intention-to-treat cohort. After the index ablation, log-rank testing over 1000 days of follow-up demonstrated that there were statistically significant differences in favour of cryoballoon ablation with respect to repeat ablations (11.8% cryoballoon vs. 17.6% RFC; P = 0.03), direct-current cardioversions (3.2% cryoballoon vs. 6.4% RFC; P = 0.04), all-cause rehospitalizations (32.6% cryoballoon vs. 41.5% RFC; P = 0.01), and cardiovascular rehospitalizations (23.8% cryoballoon vs. 35.9% RFC; P < 0.01). There were no statistical differences between groups in the quality-of-life surveys (both mental and physical) as measured by the Short Form-12 health survey and the EuroQol five-dimension questionnaire. There was an improvement in both mental and physical quality-of-life in all patients that began at 6 months after the index ablation and was maintained throughout the 30 months of follow-up. Conclusion: Patients treated with cryoballoon as opposed to RFC ablation had significantly fewer repeat ablations, direct-current cardioversions, all-cause rehospitalizations, and cardiovascular rehospitalizations during follow-up. Both patient groups improved in quality-of-life scores after AF ablation. Clinical trial registration: identifier: NCT01490814.

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Author:Karl-Heinz Kuck, Alexander Fürnkranz, Kyoung-Ryul Julian Chun, Andreas Metzner, Feifan Ouyang, Michael Schlüter, Arif Elvan, Hae W. Lim, Fred J. Kueffer, Thomas Arentz, Jean-Paul Albenque, Claudio Tondo, Michael Kühne, Christian Sticherling, Josep Brugada
Pubmed Id:
Parent Title (English):Implementation science
Publisher:BioMed Central
Place of publication:London
Document Type:Article
Year of Completion:2016
Date of first Publication:2016/07/05
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Contributing Corporation:FIRE AND ICE Investigators
Release Date:2018/04/19
Tag:Atrial fibrillation; Catheter ablation; Cryoballoon; Follow-up; Radiofrequency; Rehospitalization
Page Number:8
First Page:2858
Last Page:2865
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact
Institutes:Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (English):License LogoCreative Commons - Namensnennung-Nicht kommerziell 4.0