Atrial fibrillation (AF) is the most common cardiac arrhythmia with an increasing
prevalence and burden on the health care system [
[1]
,
[2]
]. Recently, comprehensive lifestyle and risk factor modification have been shown
to reduce AF burden but there has been no new anti-arrhythmic drug discovery for many
years [
[3]
]. Catheter ablation remains an attractive strategy to combat AF in patients with
symptomatic AF despite lifestyle and pharmacological therapy. Although our understanding
of the pathophysiological mechanisms underlying AF has improved, pulmonary vein isolation
(PVI) remains the gold standard in catheter-based therapy for this complex arrhythmia
as recent research aimed at targeting putative AF drivers has not shown significant
incremental improvement in achieveing freedom from AF [
[4]
]. More recent data has demonstrated the potential merits of cryoballoon PVI over
anti-arrhythmic drugs even as a first-line option in those with symptomatic paroxysmal
AF [
[5]
,
[6]
]. Indeed, there has been a worldwide growth in the uptake of cryoballoon PVI for
AF since the initial ‘FIRE AND ICE’
1
trial demonstrated non-inferiority of cryoballoon to conventional radiofrequency
point-by-point ablation for PVI, with regard to efficacy and safety endpoints in those
with drug-refractory paroxysmal AF [
A Controlled, Prospective, Non-Inferiority, Parallel-Group, Randomised, Interventional,
Open, Blinded Outcome Assessment (PROBE-Design), Multi-centre Trial, Comparing Efficacy
and Safety of Isolation of the PVs With a Cryoballoon Catheter vs a Radiofrequency
Ablation With a ThermoCool Catheter in Patients With PAF.
[7]
]. Further, compared to radiofrequency ablation, cryoballoon PVI was found to be associated
with shorter procedure time as well as lower resource utilisation and costs, due to
fewer repeat ablations and reduced cardiovascular re-hospitalisations [
[7]
,
[8]
].Keywords
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Article info
Publication history
Published online: February 10, 2022
Identification
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© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
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- New Minimally Invasive and Tailor-Made Strategy for Cryoballoon Ablation in Patients With Paroxysmal Atrial FibrillationHeart, Lung and CirculationVol. 31Issue 4
