Second generation cryoballoon ablation for persistent atrial fibrillation: an updated meta-analysis

Abstract

The 2G-CB seems to be safe and effective in the treatment of perAF in the mid-term.

New Results in Catheter Ablation for Atrial Fibrillation

“…A growing evidence suggests that second-generation cryoballoon is also safe and effective in patients with persistent AF [29,30]. In persistent AF the isolation of the left atrial appendage as an adjunct to PVI may improve 1-year outcomes compared with the PVI-only strategy using cryoballoon [31].…”

“…The success rate of catheter ablation might improve with substrate modification techniques such as additional linear lines, ablation of complex fractionated atrial electrograms, and isolation of the left atrial appendage. The value of these techniques is controversial; however, most of the studies that compared PVI to PVI plus substrate modification were performed before the contact force era and in low-volume centers [29,31,[52][53][54][55][56]. Substrate modification of persistent AF with the ablation of additional lines may be useful if procedure is performed by experienced operators.…”

Conversion of atrial fibrillation to sinus rhythm during cryoballoon ablation: A favorable and not unusual phenomenon during second‐generation cryoballoon pulmonary vein isolation

“…Over the last decade, cryoballoon ablation (CB‐A) has emerged as an effective alternate strategy to point‐by‐point radiofrequency (RF) ablation, showing similar outcomes in terms of freedom from AF when compared to traditional techniques and also favorable data in terms of total procedural time and reproducibility . Both safety and effectiveness of the CB‐A technology were firstly assessed in patients with documented symptomatic paroxysmal AF, and then, its non‐inferiority to other energy sources was confirmed also in the setting of persistent AF . Although some differences have been described in terms of temperature behavior when CB‐A has been performed in patients with ongoing AF compared to those in sinus rhythm (SR), still this procedure can be performed regardless of the presenting cardiac rhythm, solely aimed at electrically isolating the pulmonary veins (PVs) from the left atrium (LA).…”

“…4 Both safety and effectiveness of the CB-A technology were firstly assessed in patients with documented symptomatic paroxysmal AF, 5 and then, its non-inferiority to other energy sources was confirmed also in the setting of persistent AF. 6,7 Although some differences have been described in terms of temperature behavior when CB-A has been performed in patients with ongoing AF compared to those in sinus rhythm (SR), 8 still this procedure can be performed regardless of the presenting cardiac rhythm, solely aimed at electrically isolating the pulmonary veins (PVs) from the left atrium (LA). Since in the stepwise RF ablation approach, 9,10 whose main goal is the intra-procedural AF termination achieved by different and sequential ablation approaches, conversion of AF to SR has then been demonstrated to be a strong predictor for single-procedure success, 11 restoration of SR during CB-A PVI might also correlate with the clinical outcome.…”

HFREF Patients and Atrial Fibrillation: Time to Reconsider the Appropriateness of the Atrial Fibrillation Ablation in This Patient Subset?

“…Moreover, in the last period, there have been numerous attempts to make the technique in question as feasible and effective as possible with the addition of further technological innovations such as cryoablation [2]. However, recently, dissonant voices have arisen.…”