Cryoballoon pulmonary vein isolation as a standard approach for interventional treatment of atrial fibrillation. A review and a practical guide to an effective and safe procedure

Abstract

Since the cryoballoon was introduced into clinical practice, approximately half a million patients have undergone a pulmonary vein isolation (PVI) using this tool throughout the world. This single-shot technique makes the pulmonary vein isolation procedure easier and has the potential to expand access to the interventional treatment of atrial fibrillation (AF), eventually leading to a reduction of the AF-related disease burden. Several studies and metanalyses have assessed the acute and long-term efficacy of cryoballoon-based PVI. The reported success rate of PV isolation during the procedure is about 98%. Despite this, the long-term effectiveness of the procedure (AF free survival) assessed at 1 year after the ablation is in the range of 70–82%. The AF-free survival rate significantly depends on the clinical characteristics of the studied group and the presence of risk factors, especially the type of AF (paroxysmal vs. persistent), LA size and the presence of heart failure. For a safe and effective procedure the electrophysiologist should be aware of all minute details of the procedure including several tricks developed by the most experienced operators and the pre-procedural and post-procedural management recommendations. Detailed knowledge of complications of cryoballoon (CB)-based ablation is mandatory. This review concentrates on the practical aspects and recommendations for a cryoballoon ablation procedure. The review is based on the authors’ experience, including 800 procedures performed over 11 years with a low complication rate, and is presented within the context of the literature.

Comparison of six risk scores for the prediction of atrial fibrillation recurrence after cryoballoon‐based ablation and development of a simplified method, the 0‐1‐2 PL score

“…During the procedure, intravenous heparin was administered to achieve an activated clotting time of >350 s; measurements were performed every 30‐40 minutes. The procedure generally followed published expert consensus recommendations and was described by us in detail elsewhere 11,12 . Optimal vein occlusion with total contrast retention, ie, no back flow to the atrium was aimed for; when this was not possible, a "pull‐down" maneuver or overlapping applications was used.…”

Patent foramen ovale and left atrial appendage flow velocity predict atrial fibrillation recurrence post cryoballoon ablation

“…As a result the trans-PFO access may limit the access to pulmonary veins and hinder the successful creation of permanent lesions around PVs' ostia. Our approach/strategy of cryoballoon-based PVI was described in detail elsewhere [12][13] and generally followed the expert consensus recommendations [14]. The procedural endpoint was the electrical isolation of all PVs.…”

Predictive value of HMGB1 for atrial fibrillation recurrence after cryoballoon ablation in paroxysmal atrial fibrillation patients

“…However, this process causes an injury to the atrium tissue and inflammation. 25,26 The previous study has shown that elevation of inflammatory serum biomarkers is associated with the onset and recurrence of AF. 27 Therefore, the role of inflammation in AF recurrence has been recently proposed as a new hypothesis to explain the high rate of F I G U R E 1 Receiver-operating characteristic analysis of postoperative high-mobility group box 1.…”

“…By inducing frozen damage on the myocardial cells, CBA forms a conduction block at the ablation site. However, this process causes an injury to the atrium tissue and inflammation 25,26 …”