Recent advances in cryoballoon ablation for atrial fibrillation

ABSTRACT

Introduction: Pulmonary vein isolation (PVI), by catheter ablation, represents the current treatment for drug-resistant atrial fibrillation (AF). Nowadays cryoballoon (CB) is a recognized ablation method in patients with atrial fibrillation, mainly due to its ease of use, leading to reproducible and fast procedures. This novel single shot technology literally revolutionized the approach to AF ablation.

Areas covered: The historical development of the cryoballoon, ablation techniques and new approaches beyond the ordinary PVI and complications are summarized here.

Expert opinion: Although cryoballoon ablation has greatly standardized the approach to PVI a few critical points still need to be clarified scientifically in order to further uniform this procedure in cath labs worldwide. Duration and dosage of the cryoapplication is undoubtedly a topic of great interest.

KEYWORDS:

• Appendage isolation
• atrial fibrillation
• autonomic nervous system
• catheter ablation
• cryoablation
• cryoballoon
• ganglionated plexi
• left atrial posterior wall isolation pulmonary vein isolation

Article highlights

• Cryoballoon and the single shot literally revolutionized the approach to AF ablation.

• The fourth generation CB was released in 2018 with a 40% shorter tip if compared to the second gen. to allow a higher visualization of the time-to-isolation which is a significant predictor of chronic permanency of PVI during CB ablation

• One single application is sufficient to guarantee the permanency of electrical isolation in most veins if the required temperature of −40°C and acute electrical isolation are obtained within 60 seconds.

• Additional ablation strategies, such as ganglionated plexi ablation, left atrial posterior wall isolation, and appendage isolation, has been proposed in patients affected by more advanced forms of AF.

Declaration of interest

C de Asmundis receives compensation for teaching purposes and proctoring from AF solutions, Medtronic, Abbott, Biotronik, Atricure and research grants on behalf of the center from Biotronik, Medtronic, St Jude Medical Abbot, Livanova, Boston Scientific Biosense Webster. GB Chierchia receives compensation for teaching purposes and proctoring from AF solutions Medtronic and Biotronik. P Brugada receives and speakers fees from Biotronik, Medtronic. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.