Evaluation of myocardial injury induced by different ablation approaches (radiofrequency ablation versus cryoablation) in atrial flutter patients: a meta-analysis

Background: To evaluate myocardial injury in Atrial flutter（AFL） patients undergoing Radiofrequency ablation（RF） and cryoablation (CRYO) treatments. Methods: We conducted a systematic search on PubMed, EMBASE, Cochrane Library, and CBM databases. All relevant clinical trials (up to October 2018) on myocardial injury in AFL patients were retrieved and subsequent results analyzed with a random-effects model or a fixed-effects model. Results: A total of eight clinical trials with a sample size of 644 patients, were identified and incorporated in this study. The results indicated no significant differences in creatine kinase (CK) levels (MD=62.74, P=0.46; 4-6 hours and MD=30.73, P=0.49; 12-24 hours after ablation), cardiac isoenzyme MB (CK-MB) levels (MD=17.32, P=0.25; 12-24 hours post-ablation), troponinI (TnI) levels (MD=0.12, P=0.08; 6 hours after ablation), and troponin T (TnT) levels (MD=0.30, P=0.08; 4-6 hours post-ablation) between the two treatment approaches. However, patients receiving cryoablation exhibited higher levels of CK (MD=179.54, P=0.04; tested immediately after the procedure), CK-MB (MD=10.08, P=0.004) 4-6 hours after ablation, and TnT (MD=0.19, P=0.002) tested the next morning. Moreover, those patients had a significantly reduced pain perception (OR=0.05, P=0.04) compared to those in the RF group. Conclusion: These results indicate that CRYO in comparison to RF significantly increases myocardial injury in AFL patients. Additionally, it decreases pain perception during the procedure. Further large-sampled studies are needed to support these findings.