Best Practice Guide for Cryoballoon Ablation in Atrial Fibrillation: The Compilation Experience of More than 1000 Procedures

Author:

Tsiachris Dimitriοs12ORCID,Antoniou Christos-Konstantinos1ORCID,Doundoulakis Ioannis23ORCID,Manolakou Panagiota1,Sougiannis Demetrios1,Kordalis Athanasios2,Gatzoulis Konstantinos A.2,Chierchia Gian-Battista3,de Asmundis Carlo3ORCID,Stefanadis Christodoulos14,Tsioufis Konstantinos2

Affiliation:

1. Athens Heart Centre Athens Medical Centre, 11526 Athens, Greece

2. First Department of Cardiology, National and Kapodistrian University, Hippokration Hospital, 11527 Athens, Greece

3. Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium

4. Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT 06510, USA

Abstract

Nowadays, the cryoballoon (CB) constitutes an established alternative to radio frequency (RF) ablation for pulmonary vein isolation (PVI), which offers the possibility to isolate the PVs with a single application. Since the introduction of the second-generation CB, we prospectively collected our data to optimize the procedure on >1000 consecutive patients who underwent CB PVI performed in our center. It is expected that subsequent guidelines will suggest first-line PVI through CB in patients with paroxysmal AF with a class I indication. Indeed, in the long-term follow-up (36 months) of the EARLY-AF trial, CB had a lower incidence of persistent atrial fibrillation episodes compared to the anti-arrhythmic drugs group. We now review the current best practices in an effort to drive consistent outcomes and minimize complications. PV isolation through CB is the most studied single-shot technique for atrial fibrillation ablation, having shown the potential to alter the natural history of the arrhythmia. Several procedural tips and tricks can improve procedural flow and effectiveness. In the present article we provided not only technical details but measurable biophysical parameters that can reliably guide the operator into achieving the best outcome for his patients.

Publisher

MDPI AG

Subject

Pharmacology (medical),General Pharmacology, Toxicology and Pharmaceutics

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