{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T03:26:26Z","timestamp":1793935586992,"version":"4.8.0"},"reference-count":54,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Pulmonary vein isolation (PVI) alone achieves modest arrhythmia freedom in persistent atrial fibrillation (PeAF). Cryoballoon ablation (CBA) offers a single\u2010shot alternative to radiofrequency ablation (RFA) that streamlines procedural workflow. We aimed to quantify the clinical efficacy, procedural efficiency, and safety of CBA versus RFA through a meta\u2010analysis of randomized controlled trials (RCTs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p>\n                      Systematic review of PubMed, Embase, and Scopus identified 5 RCTs enrolling 1,091 patients (515 CBA, 576 RFA). The primary endpoint was 12\u2010month freedom from any atrial arrhythmia, with isolated AF, and atrial tachycardia\/flutter evaluated as secondary endpoints. Random\u2010effects models generated relative risks (RRs) and mean differences (MDs) with 95% confidence intervals (CI). Time\u2010to\u2010event data were pooled using a generic inverse\u2010variance approach to derive hazard ratios (HR). CBA and RFA demonstrated equivalent freedom from any arrhythmia (RR 0.97, 95% CI 0.81\u20131.15;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.71). Time\u2010to\u2010event analysis corroborated a comparable recurrence hazard (HR 0.91, 95% CI 0.67\u20131.24;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.56;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 0%). Repeat ablation rates were identical (RR 0.93;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.50). CBA significantly reduced procedural time (MD \u221245.37\u00a0min; p &lt; 0.0001), while major complications were comparable (1.5%\u00a0vs. 2.7%;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.18). Trial sequential analysis indicated that further randomization is unlikely to demonstrate superiority.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In PeAF, CBA and RFA achieve equivalent 12\u2010month arrhythmia\u2010free survival and comparable repeat\u2010ablation rates, while CBA confers a highly significant reduction in procedural time. However, reliance on 12\u2010month follow\u2010up and heterogeneous rhythm surveillance protocols may limit assessments of true long\u2010term durability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pace.70350","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T12:21:56Z","timestamp":1783081316000},"page":"1692-1705","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cryoballoon Versus Radiofrequency Ablation for Persistent Atrial Fibrillation: Meta\u2010Analysis of Randomized Trials"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5197-9728","authenticated-orcid":false,"given":"Harroop","family":"Bola","sequence":"first","affiliation":[{"name":"Faculty of Medicine Imperial College London, England  London UK"},{"name":"London Northwest Healthcare NHS Trust, England  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5901-8694","authenticated-orcid":false,"given":"Aksaan","family":"Arif","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Imperial College London, England  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1073-5825","authenticated-orcid":false,"given":"Joshua","family":"J. Hon","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Imperial College London, England  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gayathri","family":"Giritharan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Imperial College London, England  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prachur","family":"Khandelwal","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Imperial College London, England  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodrick","family":"Avakian","sequence":"additional","affiliation":[{"name":"London Northwest Healthcare NHS Trust, England  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amar","family":"Rai","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Imperial College London, England  London UK"},{"name":"Department of Internal Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiran Haresh Kumar","family":"Patel","sequence":"additional","affiliation":[{"name":"London Northwest Healthcare NHS Trust, England  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fu Siong","family":"Ng","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Imperial College London, England  London UK"},{"name":"Chelsea and Westminster Hospital NHS Foundation Trust, England  London UK"},{"name":"National Heart and Lung Institute Imperial College London, England  London UK"},{"name":"Department of Cardiology Imperial College Healthcare NHS Trust, England  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euae043"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.23722"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2019.05.012"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12872\u2010020\u201001459\u20104"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1540\u20108167.2004.04052.x"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.104.533190"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1602014"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.119.042622"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euab281"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2022.08.031"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.15965"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaf451"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2025.08.003"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40001\u2010025\u201002911\u2010x"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_11_17_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins J. 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