Current status and prospects of cryoballoon ablation in first-line treatment of atrial fibrillation_West China Medical Journal

Authors：

XIE Min ^1,2 ,  CUI Kaijun ¹

1. Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Cardiology, Chengdu Seventh People’s Hospital, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

CUI Kaijun, Email: cuikaijunscu@163.com

Keywords：

Arrhythmias; atrial fibrillation; catheter ablation; cryoballoon ablation

DOI：

10.7507/1002-0179.202309152

Video：

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Atrial fibrillation is the most common arrhythmia in clinical practice, and catheter ablation has become a first-line treatment strategy. Among them, cryoballoon ablation has become a standardized treatment for atrial fibrillation due to its advantages such as short surgical time, short learning curve, and minimal patient pain. Currently, a large amount of clinical practice and research have provided new evidence for cryoballoon ablation as a first-line treatment for atrial fibrillation. Therefore, this article provides a review of the current status of catheter ablation, the current status, challenges faced, and prospects as a first-line catheter ablation strategy for atrial fibrillation of cryoballoon ablation, with the aim of providing reference for cardiologists in clinical decision-making in the initial rhythm control of atrial fibrillation.

Citation： XIE Min, CUI Kaijun. Current status and prospects of cryoballoon ablation in first-line treatment of atrial fibrillation. West China Medical Journal, 2024, 39(4): 640-644. doi: 10.7507/1002-0179.202309152 Copy

1.	Adderley NJ, Ryan R, Nirantharakumar K, et al. Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016. Heart, 2019, 105(1): 27-33.
2.	Vaduganathan M, Mensah GA, Turco JV, et al. The global burden of cardiovascular diseases and risk: a compass for future health. J Am Coll Cardiol, 2022, 80(25): 2361-2371.
3.	Kirchhof P, Camm AJ, Goette A, et al. Early rhythm-control therapy in patients with atrial fibrillation. N Engl J Med, 2020, 383(14): 1305-1316.
4.	Turagam MK, Musikantow D, Whang W, et al. Assessment of catheter ablation or antiarrhythmic drugs for first-line therapy of atrial fibrillation: a meta-analysis of randomized clinical trials. JAMA Cardiol, 2021, 6(6): 697-705.
5.	Wazni OM, Marrouche NF, Martin DO, et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial. JAMA, 2005, 293(21): 2634-2640.
6.	Cosedis Nielsen J, Johannessen A, Raatikainen P, et al. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation. N Engl J Med, 2012, 367(17): 1587-1595.
7.	Morillo CA, Verma A, Connolly SJ, et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation (RAAFT-2): a randomized trial. JAMA, 2014, 311(7): 692-700.
8.	Andrade JG, Wazni OM, Kuniss M, et al. Cryoballoon ablation as initial treatment for atrial fibrillation: JACC state-of-the-art review. J Am Coll Cardiol, 2021, 78(9): 914-930.
9.	Mark DB, Anstrom KJ, Sheng S, et al. Effect of catheter ablation vs medical therapy on quality of life among patients with atrial fibrillation: the CABANA randomized clinical trial. JAMA, 2019, 321(13): 1275-1285.
10.	中华医学会心血管病学分会, 中国生物医学工程学会心律分会. 心房颤动诊断和治疗中国指南. 中华心血管病杂志, 2023, 51(6): 572-618.
11.	Hindricks G, Potpara T, Dagres N, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J, 2021, 42(5): 373-498.
12.	January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines and the Heart Rhythm Society in collaboration with the Society of Thoracic Surgeons. Circulation, 2019, 140(2): e125-e151.
13.	Andrade JG, Aguilar M, Atzema C, et al. The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society comprehensive guidelines for the management of atrial fibrillation. Can J Cardiol, 2020, 36(12): 1847-1948.
14.	Cheung CC, Nattel S, Macle L, et al. Management of atrial fibrillation in 2021: an updated comparison of the current CCS/CHRS, ESC, and AHA/ACC/HRS guidelines. Can J Cardiol, 2021, 37(10): 1607-1618.
15.	中华医学会心电生理和起搏分会, 中国医师协会心律学专业委员会, 中国房颤中心联盟心房颤动防治专家工作委员会. 心房颤动: 目前的认识和治疗建议(2021). 中华心律失常学杂志, 2022, 26(1): 15-88.
16.	Andrade JG, Wells GA, Deyell MW, et al. Cryoablation or drug therapy for initial treatment of atrial fibrillation. N Engl J Med, 2021, 384(4): 305-315.
17.	Wazni OM, Dandamudi G, Sood N, et al. Cryoballoon ablation as initial therapy for atrial fibrillation. N Engl J Med, 2021, 384(4): 316-324.
18.	Kuniss M, Pavlovic N, Velagic V, et al. Cryoballoon ablation vs. antiarrhythmic drugs: first-line therapy for patients with paroxysmal atrial fibrillation. Europace, 2021, 23(7): 1033-1041.
19.	Kuck KH, Brugada J, Fürnkranz A, et al. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation. N Engl J Med, 2016, 374(23): 2235-2245.
20.	白剑, 王绍娴, 郑甲, 等. 射频消融与冷冻球囊消融治疗阵发性心房颤动的疗效观察. 中华心律失常学杂志, 2020, 24(3): 303-307.
21.	Providencia R, Defaye P, Lambiase PD, et al. Results from a multicentre comparison of cryoballoon vs. radiofrequency ablation for paroxysmal atrial fibrillation: is cryoablation more reproducible?. Europace, 2017, 19(1): 48-57.
22.	Yan F, Zhao S, Wu W, et al. Different effects of additional ganglion plexus ablation on catheter and surgical ablation for atrial fibrillation: a systemic review and meta-analysis. J Cardiovasc Electrophysiol, 2019, 30(12): 3039-3049.
23.	王英, 张郁青, 周秀娟. 经导管冷冻球囊消融治疗阵发性心房颤动对心率变异性的影响. 江苏医药, 2020, 46(2): 158-161.
24.	Lemoine MD, Mencke C, Nies M, et al. Pulmonary vein isolation by pulsed-field ablation induces less neurocardiac damage than cryoballoon ablation. Circ Arrhythm Electrophysiol, 2023, 16(4): e011598.
25.	Shi LB, Rossvoll O, Tande P, et al. Cryoballoon vs. radiofrequency catheter ablation: insights from NOrwegian randomized study of PERSistent Atrial Fibrillation (NO-PERSAF study). Europace, 2022, 24(2): 226-233.
26.	Su WW, Reddy VY, Bhasin K, et al. Cryoballoon ablation of pulmonary veins for persistent atrial fibrillation: results from the multicenter STOP persistent AF trial. Heart Rhythm, 2020, 17(11): 1841-1847.
27.	Omran H, Gutleben KJ, Molatta S, et al. Second generation cryoballoon ablation for persistent atrial fibrillation: an updated meta-analysis. Clin Res Cardiol, 2018, 107(2): 182-192.
28.	Heeger CH, Tscholl V, Wissner E, et al. Acute efficacy, safety, and long-term clinical outcomes using the second-generation cryoballoon for pulmonary vein isolation in patients with a left common pulmonary vein: a multicenter study. Heart Rhythm, 2017, 14(8): 1111-1118.
29.	Beiert T, Lodde PC, Linneborn LPT, et al. Outcome in patients with left common pulmonary vein after cryoablation with second-generation cryoballoon. Pacing Clin Electrophysiol, 2018, 41(1): 22-27.
30.	De Potter T, Klaver M, Babkin A, et al. Ultra-low temperature cryoablation for atrial fibrillation: primary outcomes for efficacy and safety: the Cryocure-2 study. JACC Clin Electrophysiol, 2022, 8(8): 1034-1039.
31.	Akkaya E, Berkowitsch A, Rieth A, et al. Clinical outcome and left atrial function after left atrial roof ablation using the cryoballoon technique in patients with symptomatic persistent atrial fibrillation. Int J Cardiol, 2019, 292: 112-118.
32.	DeLurgio DB, Crossen KJ, Gill J, et al. Hybrid convergent procedure for the treatment of persistent and long-standing persistent atrial fibrillation: results of CONVERGE clinical trial. Circ Arrhythm Electrophysiol, 2020, 13(12): e009288.
33.	Moltrasio M, Sicuso R, Fassini GM, et al. Acute outcome after a single cryoballoon ablation: comparison between arctic front advance and arctic front advance PRO. Pacing Clin Electrophysiol, 2019, 42(7): 890-896.
34.	Chierchia GB, Mugnai G, Ströker E, et al. Incidence of real-time recordings of pulmonary vein potentials using the third-generation short-tip cryoballoon. Europace, 2016, 18(8): 1158-1163.
35.	Assaf A, Bhagwandien R, Szili-Torok T, et al. Comparison of procedural efficacy, balloon nadir temperature, and incidence of phrenic nerve palsy between two cryoballoon technologies for pulmonary vein isolation: a systematic review and meta-analysis. J Cardiovasc Electrophysiol, 2021, 32(9): 2424-2431.
36.	刘俊, 李维昇, 龚杰, 等. 新型国产冷冻球囊消融系统进行犬肺静脉电隔离的实验研究. 中国循环杂志, 2023, 38(8): 861-866.
37.	Verma A, Jiang CY, Betts TR, et al. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med, 2015, 372(19): 1812-1822.

1. Adderley NJ, Ryan R, Nirantharakumar K, et al. Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016. Heart, 2019, 105(1): 27-33.
2. Vaduganathan M, Mensah GA, Turco JV, et al. The global burden of cardiovascular diseases and risk: a compass for future health. J Am Coll Cardiol, 2022, 80(25): 2361-2371.
3. Kirchhof P, Camm AJ, Goette A, et al. Early rhythm-control therapy in patients with atrial fibrillation. N Engl J Med, 2020, 383(14): 1305-1316.
4. Turagam MK, Musikantow D, Whang W, et al. Assessment of catheter ablation or antiarrhythmic drugs for first-line therapy of atrial fibrillation: a meta-analysis of randomized clinical trials. JAMA Cardiol, 2021, 6(6): 697-705.
5. Wazni OM, Marrouche NF, Martin DO, et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial. JAMA, 2005, 293(21): 2634-2640.
6. Cosedis Nielsen J, Johannessen A, Raatikainen P, et al. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation. N Engl J Med, 2012, 367(17): 1587-1595.
7. Morillo CA, Verma A, Connolly SJ, et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation (RAAFT-2): a randomized trial. JAMA, 2014, 311(7): 692-700.
8. Andrade JG, Wazni OM, Kuniss M, et al. Cryoballoon ablation as initial treatment for atrial fibrillation: JACC state-of-the-art review. J Am Coll Cardiol, 2021, 78(9): 914-930.
9. Mark DB, Anstrom KJ, Sheng S, et al. Effect of catheter ablation vs medical therapy on quality of life among patients with atrial fibrillation: the CABANA randomized clinical trial. JAMA, 2019, 321(13): 1275-1285.
10. 中华医学会心血管病学分会, 中国生物医学工程学会心律分会. 心房颤动诊断和治疗中国指南. 中华心血管病杂志, 2023, 51(6): 572-618.
11. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J, 2021, 42(5): 373-498.
12. January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines and the Heart Rhythm Society in collaboration with the Society of Thoracic Surgeons. Circulation, 2019, 140(2): e125-e151.
13. Andrade JG, Aguilar M, Atzema C, et al. The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society comprehensive guidelines for the management of atrial fibrillation. Can J Cardiol, 2020, 36(12): 1847-1948.
14. Cheung CC, Nattel S, Macle L, et al. Management of atrial fibrillation in 2021: an updated comparison of the current CCS/CHRS, ESC, and AHA/ACC/HRS guidelines. Can J Cardiol, 2021, 37(10): 1607-1618.
15. 中华医学会心电生理和起搏分会, 中国医师协会心律学专业委员会, 中国房颤中心联盟心房颤动防治专家工作委员会. 心房颤动: 目前的认识和治疗建议(2021). 中华心律失常学杂志, 2022, 26(1): 15-88.
16. Andrade JG, Wells GA, Deyell MW, et al. Cryoablation or drug therapy for initial treatment of atrial fibrillation. N Engl J Med, 2021, 384(4): 305-315.
17. Wazni OM, Dandamudi G, Sood N, et al. Cryoballoon ablation as initial therapy for atrial fibrillation. N Engl J Med, 2021, 384(4): 316-324.
18. Kuniss M, Pavlovic N, Velagic V, et al. Cryoballoon ablation vs. antiarrhythmic drugs: first-line therapy for patients with paroxysmal atrial fibrillation. Europace, 2021, 23(7): 1033-1041.
19. Kuck KH, Brugada J, Fürnkranz A, et al. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation. N Engl J Med, 2016, 374(23): 2235-2245.
20. 白剑, 王绍娴, 郑甲, 等. 射频消融与冷冻球囊消融治疗阵发性心房颤动的疗效观察. 中华心律失常学杂志, 2020, 24(3): 303-307.
21. Providencia R, Defaye P, Lambiase PD, et al. Results from a multicentre comparison of cryoballoon vs. radiofrequency ablation for paroxysmal atrial fibrillation: is cryoablation more reproducible?. Europace, 2017, 19(1): 48-57.
22. Yan F, Zhao S, Wu W, et al. Different effects of additional ganglion plexus ablation on catheter and surgical ablation for atrial fibrillation: a systemic review and meta-analysis. J Cardiovasc Electrophysiol, 2019, 30(12): 3039-3049.
23. 王英, 张郁青, 周秀娟. 经导管冷冻球囊消融治疗阵发性心房颤动对心率变异性的影响. 江苏医药, 2020, 46(2): 158-161.
24. Lemoine MD, Mencke C, Nies M, et al. Pulmonary vein isolation by pulsed-field ablation induces less neurocardiac damage than cryoballoon ablation. Circ Arrhythm Electrophysiol, 2023, 16(4): e011598.
25. Shi LB, Rossvoll O, Tande P, et al. Cryoballoon vs. radiofrequency catheter ablation: insights from NOrwegian randomized study of PERSistent Atrial Fibrillation (NO-PERSAF study). Europace, 2022, 24(2): 226-233.
26. Su WW, Reddy VY, Bhasin K, et al. Cryoballoon ablation of pulmonary veins for persistent atrial fibrillation: results from the multicenter STOP persistent AF trial. Heart Rhythm, 2020, 17(11): 1841-1847.
27. Omran H, Gutleben KJ, Molatta S, et al. Second generation cryoballoon ablation for persistent atrial fibrillation: an updated meta-analysis. Clin Res Cardiol, 2018, 107(2): 182-192.
28. Heeger CH, Tscholl V, Wissner E, et al. Acute efficacy, safety, and long-term clinical outcomes using the second-generation cryoballoon for pulmonary vein isolation in patients with a left common pulmonary vein: a multicenter study. Heart Rhythm, 2017, 14(8): 1111-1118.
29. Beiert T, Lodde PC, Linneborn LPT, et al. Outcome in patients with left common pulmonary vein after cryoablation with second-generation cryoballoon. Pacing Clin Electrophysiol, 2018, 41(1): 22-27.
30. De Potter T, Klaver M, Babkin A, et al. Ultra-low temperature cryoablation for atrial fibrillation: primary outcomes for efficacy and safety: the Cryocure-2 study. JACC Clin Electrophysiol, 2022, 8(8): 1034-1039.
31. Akkaya E, Berkowitsch A, Rieth A, et al. Clinical outcome and left atrial function after left atrial roof ablation using the cryoballoon technique in patients with symptomatic persistent atrial fibrillation. Int J Cardiol, 2019, 292: 112-118.
32. DeLurgio DB, Crossen KJ, Gill J, et al. Hybrid convergent procedure for the treatment of persistent and long-standing persistent atrial fibrillation: results of CONVERGE clinical trial. Circ Arrhythm Electrophysiol, 2020, 13(12): e009288.
33. Moltrasio M, Sicuso R, Fassini GM, et al. Acute outcome after a single cryoballoon ablation: comparison between arctic front advance and arctic front advance PRO. Pacing Clin Electrophysiol, 2019, 42(7): 890-896.
34. Chierchia GB, Mugnai G, Ströker E, et al. Incidence of real-time recordings of pulmonary vein potentials using the third-generation short-tip cryoballoon. Europace, 2016, 18(8): 1158-1163.
35. Assaf A, Bhagwandien R, Szili-Torok T, et al. Comparison of procedural efficacy, balloon nadir temperature, and incidence of phrenic nerve palsy between two cryoballoon technologies for pulmonary vein isolation: a systematic review and meta-analysis. J Cardiovasc Electrophysiol, 2021, 32(9): 2424-2431.
36. 刘俊, 李维昇, 龚杰, 等. 新型国产冷冻球囊消融系统进行犬肺静脉电隔离的实验研究. 中国循环杂志, 2023, 38(8): 861-866.
37. Verma A, Jiang CY, Betts TR, et al. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med, 2015, 372(19): 1812-1822.

West China Medical Journal

Current status and prospects of cryoballoon ablation in first-line treatment of atrial fibrillation

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