Pulmonary vein isolation with the Medtronic cryoballoon is an increasingly popular
approach for the treatment of paroxysmal atrial fibrillation (AF). In a head-to-head
comparison, cryoablation has been shown to be equally effective to radiofrequency
ablation for paroxysmal AF, with the benefit of shorter procedure times.
1
Since the approval of the second-generation cryoballoon, the Arctic Front Advance,
in April 2012, there has been a trend toward fewer and shorter cryoablation applications
per pulmonary vein.
2
,
3
,
4
Instead of the conventional 2 cryoablation procedures of 2–4 minutes per pulmonary
vein, some sites have moved to a tailored approach, curtailing cryoablation if the
Medtronic Achieve mapping catheter reveals an early time to pulmonary vein isolation
(TT-PVI). Preliminary studies have suggested that this approach might reduce the number
and duration of cryoablation procedures, with the promise of even shorter fluoroscopy
and procedure times.
5
,
- Aryana A.
- Kowalski M.
- O’Neill P.G.
- Koo C.H.
- Lim H.W.
- Khan A.
- Hokanson R.B.
- Bowers M.R.
- Kenigsberg D.N.
- Ellenbogen K.A.
- Cryo D.I.
Catheter ablation using the third-generation cryoballoon provides an enhanced ability
to assess time to pulmonary vein isolation facilitating the ablation strategy: short-
and long-term results of a multicenter study.
Heart Rhythm. 2016; 13: 2306-2313
6
- Chan N.Y.
- Yuen H.C.
- Chu P.S.
- Choy C.C.
- Chow H.F.
- Fong H.F.
- Lau C.L.
- Lo Y.K.
- Tsui P.T.
- Lau S.T.
- Mok N.S.
Inner lumen mapping catheter-facilitated big cryoballoon treatment for atrial fibrillation
shortens procedural duration and fluoroscopic exposure with comparable mid-term efficacy.
J Interv Card Electrophysiol. 2013; 37: 169-177
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References
- Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation.N Engl J Med. 2016; 374: 2235-2245
- Single 3-minute freeze for second-generation cryoballoon ablation: one-year follow-up after pulmonary vein isolation.Heart Rhythm. 2015; 12: 673-680
- Improved procedural efficacy of pulmonary vein isolation using the novel second-generation cryoballoon.J Cardiovasc Electrophysiol. 2013; 24: 492-497
- One-year clinical outcome after pulmonary vein isolation using the second-generation 28-mm cryoballoon.Circ Arrhythm Electrophysiol. 2014; 7: 288-292
- Catheter ablation using the third-generation cryoballoon provides an enhanced ability to assess time to pulmonary vein isolation facilitating the ablation strategy: short- and long-term results of a multicenter study.Heart Rhythm. 2016; 13: 2306-2313
- Inner lumen mapping catheter-facilitated big cryoballoon treatment for atrial fibrillation shortens procedural duration and fluoroscopic exposure with comparable mid-term efficacy.J Interv Card Electrophysiol. 2013; 37: 169-177
- Verification of a novel atrial fibrillation cryoablation dosing algorithm guided by time-to-pulmonary vein isolation: results from the Cryo-DOSING Study (Cryoballoon-ablation DOSING Based on the Assessment of Time-to-Effect and Pulmonary Vein Isolation Guidance).Heart Rhythm. 2017; 14: 1319-1325
- Cancer risks associated with external radiation from diagnostic imaging procedures.CA Cancer J Clin. 2012; 62: 75-100
- Circumferential pulmonary vein ablation with additional linear ablation results in an increased incidence of left atrial flutter compared with segmental pulmonary vein isolation as an initial approach to ablation of paroxysmal atrial fibrillation.Circ Arrhythm Electrophysiol. 2010; 3: 243-248
Article info
Publication history
Published online: July 13, 2017
Footnotes
Dr Lee is the principal investigator of the One Freeze Trial, a multicenter randomized controlled trial of the cryoballoon sponsored by Medtronic. Dr Marcus receives research support from the National Institutes of Health, Patient-Centered Outcomes Research Institute, Medtronic, and Cardiogram; is a consultant for LifeWatch and InCarda; and holds equity in InCarda.
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© 2017 Heart Rhythm Society. All rights reserved.
