FIRE AND ICE Trial: Cryoballoon or RF ablation for paroxysmal atrial fibrillation

The objective of FIRE AND ICE trial is to compare balloon cryoablation with traditional radiofrequency ablation (RFA) in terms of long-term atrial fibrillation-free survival in patients with symptomatic paroxysmal atrial fibrillation (PAF).

Patients with symptomatic PAF with at least two episodes (30s episode documented by ECG) and treatment failure of at least one antiarrhythmic drug were included in the study.

762 patients were randomized to either radiofrequency ablation or cryoablation. The primary outcome was the treatment failure (recurrent AF, need for AAD, repeat ablation) which was found to be equivalent in both groups.

Thus, the authors concluded that cryoballoon ablation was noninferior to radiofrequency ablation with respect to efficacy for the treatment of patients with drug-refractory paroxysmal atrial fibrillation, and there was no significant difference between the two methods with regard to overall safety.