Persistent Atrial Fibrillation Using Arctic Front™ Cardiac Cryoablation System
Cryoablation of atrial fibrillation with Arctic FrontTM family of cryoballoons has radically altered the landscape of electrophysiology since its introduction just over a decade ago. We have seen the initially promising results in pulmonary vein isolation (PVI) for paroxysmal AF become highly reproducible as technological and procedural advances have been implemented, and cryoablation is routinely considered as equivalent in efficacy to radiofrequency ablation.1 As this efficacy and safety profile of the technique has been established, balloon cryoablation for pulmonary vein isolation (cryo-PVI) has become a first-line procedure for paroxysmal AF patients.2
Of course, the discovery that PVI alone provides an equivalent or better outcome than PVI plus empiric lines/fractionated electrogram ablation opened the door for cryo-PVI in patients with persistent AF, greatly expanding the patient base for whom this could be a useful treatment.3
The prospect of a highly reproducible procedure, with little intra-operator variability is greatly appealing: high throughput services could be configured, day case procedures established and consistent results expected. The simpler console and mapping system required for cryoablation has begun a democratisation of services. No longer must AF ablation be performed exclusively in large teaching hospitals, but satellite coronary labs can be easily converted to do this procedure.4
But as we expand the population of patients who would potentially be able to be treated with cryoablation, increasing the numbers of centres able to undertake the procedure, we must remain mindful of best practices and the continuing incremental improvements in operator techniques. Robust, rapid and safe isolation of the pulmonary veins remains the cornerstone of first line cryo-PVI for persistent AF ablation.5 The FDA just announced approval for indication expansion of the Cryoballoon to treat patients with drug refractory persistent AF. The Arctic Front family of Cardiac Cryoballoon catheters are the first devices approved for this indication by the FDA.6
We very much hope you enjoy the featured articles in this collection and find them useful in the delivery of treatment for your patients.
Dr Malcolm Finlay
In this section
The Persistent Atrial Fibrillation using Cryoballoon section is supported by Medtronic


Section advisor
Dr Malcolm Finlay, Consultant Cardiologist, Barts Heart Centre
Arctic Front Family of cryoballoons is the first FDA-approved ablation catheter for the treatment of Persistent AF in the US
Videos
Video
Treat Persistent AFVideos
Video
Treat Persistent AFFeatured Articles 
Techniques
Huang HD, Krishnan K, Sharma PS, et al. Am J Cardiol 2020;135:99–104.
Reissmann B, Heeger CH, Opitz K, et al. Cardiol J 2020; epub ahead of press.
Akkaya E, Berkowitsch A, Rieth A, et al. Int J Cardiol 2019;292:112-118.
Guckel D, Schmidt A, Gutleben KJ, et al. Heart Rhythm 2020;17;4:600-606.
Bhatia NK, Rogers AJ, Krummen DE, et al. Europace 2020. [Epub ahead of print]
Clinical publications
Stabile G, Iacopino S, Verlato R, et al. Europace 2020;22:1798–1804.
Conte G, Soejima K, de Asmundis C, et al. Europace 2020;22:1653–8.
Loring Z, Holmes DN, Matsouaka RA, et al. Circ Arrhythm Electrophysiol 2020;13:e007944.
Su WW, Reddy VY, Bhasin K, et al. Heart Rhythm 2020;17:1841–7.
Wazni OM, Dandamudi G, Sood N, et al. N Engl J Med 2021;384:316–24.
Andrade JG, Wells GA, Deyell MW, et al. N Engl J Med 2021;384:305–15.
Blomström-Lundqvist C, Gizurarson S, Schwieler J, et al. JAMA 2019;321;11:1059-1068.
Mark DB, Anstrom KJ, Sheng S, et al. JAMA 2019;321;13:1275-1285.
Packer DL, Mark DB, Robb RA, et al. JAMA 2019;321;13:1261-1274.
Verma A, Jiang C, Betts TR, et al. N Engl J Med 2015;372:1812-1822.
Kuck KH, Brugada J, Fürnkranz A, et al. N Engl J Med 2016;374:2235-2245.
Andrade JG, Champagne J, Dubuc M, et al. Circulation 2019;140;22:1779-1788.
Packer DL, Kowal RC, Wheelan KR, et al. J Am Coll Cardiol 2013;61;16:1713-1723.
Hunter RJ, Baker V, Finlay MC, et al. J Cardiovasc Electrophysiol 2015;26;12:1307-1314.
Luik A, Radzewitz A, Kieser M, et al. Circulation 2015;132;14:1311-1319.
Sutter JS, Lokhnygina Y, Daubert JP, et al. Am Heart J 2020;220:89-96.
Buist TJ, Adiyaman A, Beukema RJ, et al. Clin Res Cardiol 2020;109;2:215-224.
Kuniss M, Akkaya E, Berkowitsch A, et al. Clin Res Cardiol 2019. [Epub ahead of print]
Kuck KH, Merkely B, Zahn R, et al. Circ Arrhythm Electrophysiol 2019;12;12:e007731.
Hoffmann E, Straube F, Wegscheider K, et al. Europace 2019;21;9:1313-1324.
Yorgun H, Canpolat U, Okşul M, et al. Europace 2019;21;11:1653-1662.
Calkins H, Su W, Bhasin K, et al. JACC 2020;75;11:270
Guidelines
Santangeli P, Di Biase L, Burkhardt DJ, et al. J Cardiovasc Med (Hagerstown) 2012;13;2:108-24.
Terricabras M, Piccini JP and Verma A. J Cardiovasc Electrophysiol 2019. [Epub ahead of print].
January CT, Wann LS, Calkins H, et al. J Am Coll Cardiol 2019;74;1:104-132.
Hussein AA and Wazni OM. Europace 2020;22;3:333-334.
Elbatran AI, Anderson RH, Mori S and Saba MM. Heart Rhythm 2019;16;9:1392-1398.
Ang R, Domenichini G, Finlay MC, et al. Curr Cardiol Rep 2015;17;9:631.
Kirchhof P and Calkins H. European Heart Journal 2017;38;1:20-26.
Dan, GA. European Cardiology Review 2019;14;2:77-81.
Miyazaki, S and Tada, H. Arrhythmia & Electrophysiology Review 2019;8;1:60-64.
Faggioni M, Della Rocca DG, Mohanty S, et al. Cardiac Failure Review 2020;6:e04.
Andronache M, Drca N and Viola G. Arrhythmia & Electrophysiology Review 2019;8(2):111-5.
Garvanski I, Simova I, Angelkov L and Matveev M. European Cardiology Review 2019;14(3):165-8.
Aronis KN, Ali RL, Liang JA, et al. Arrhythmia & Electrophysiology Review 2019;8(3):210-9.
Johner N, Namdar M and Shah DC. Arrhythmia & Electrophysiology Review 2019;8(3):184-90.
Huang HD, Krishnan K, Sharma PS, et al. Am J Cardiol 2020;135:99–104.
Reissmann B, Heeger CH, Opitz K, et al. Cardiol J 2020; epub ahead of press.
Akkaya E, Berkowitsch A, Rieth A, et al. Int J Cardiol 2019;292:112-118.
Guckel D, Schmidt A, Gutleben KJ, et al. Heart Rhythm 2020;17;4:600-606.
Bhatia NK, Rogers AJ, Krummen DE, et al. Europace 2020. [Epub ahead of print]
Stabile G, Iacopino S, Verlato R, et al. Europace 2020;22:1798–1804.
Conte G, Soejima K, de Asmundis C, et al. Europace 2020;22:1653–8.
Loring Z, Holmes DN, Matsouaka RA, et al. Circ Arrhythm Electrophysiol 2020;13:e007944.
Su WW, Reddy VY, Bhasin K, et al. Heart Rhythm 2020;17:1841–7.
Wazni OM, Dandamudi G, Sood N, et al. N Engl J Med 2021;384:316–24.
Andrade JG, Wells GA, Deyell MW, et al. N Engl J Med 2021;384:305–15.
Blomström-Lundqvist C, Gizurarson S, Schwieler J, et al. JAMA 2019;321;11:1059-1068.
Mark DB, Anstrom KJ, Sheng S, et al. JAMA 2019;321;13:1275-1285.
Packer DL, Mark DB, Robb RA, et al. JAMA 2019;321;13:1261-1274.
Verma A, Jiang C, Betts TR, et al. N Engl J Med 2015;372:1812-1822.
Kuck KH, Brugada J, Fürnkranz A, et al. N Engl J Med 2016;374:2235-2245.
Andrade JG, Champagne J, Dubuc M, et al. Circulation 2019;140;22:1779-1788.
Packer DL, Kowal RC, Wheelan KR, et al. J Am Coll Cardiol 2013;61;16:1713-1723.
Hunter RJ, Baker V, Finlay MC, et al. J Cardiovasc Electrophysiol 2015;26;12:1307-1314.
Luik A, Radzewitz A, Kieser M, et al. Circulation 2015;132;14:1311-1319.
Sutter JS, Lokhnygina Y, Daubert JP, et al. Am Heart J 2020;220:89-96.
Buist TJ, Adiyaman A, Beukema RJ, et al. Clin Res Cardiol 2020;109;2:215-224.
Kuniss M, Akkaya E, Berkowitsch A, et al. Clin Res Cardiol 2019. [Epub ahead of print]
Kuck KH, Merkely B, Zahn R, et al. Circ Arrhythm Electrophysiol 2019;12;12:e007731.
Hoffmann E, Straube F, Wegscheider K, et al. Europace 2019;21;9:1313-1324.
Yorgun H, Canpolat U, Okşul M, et al. Europace 2019;21;11:1653-1662.
Calkins H, Su W, Bhasin K, et al. JACC 2020;75;11:270
Santangeli P, Di Biase L, Burkhardt DJ, et al. J Cardiovasc Med (Hagerstown) 2012;13;2:108-24.
Terricabras M, Piccini JP and Verma A. J Cardiovasc Electrophysiol 2019. [Epub ahead of print].
January CT, Wann LS, Calkins H, et al. J Am Coll Cardiol 2019;74;1:104-132.
Hussein AA and Wazni OM. Europace 2020;22;3:333-334.
Elbatran AI, Anderson RH, Mori S and Saba MM. Heart Rhythm 2019;16;9:1392-1398.
Ang R, Domenichini G, Finlay MC, et al. Curr Cardiol Rep 2015;17;9:631.
Kirchhof P and Calkins H. European Heart Journal 2017;38;1:20-26.
Dan, GA. European Cardiology Review 2019;14;2:77-81.
Miyazaki, S and Tada, H. Arrhythmia & Electrophysiology Review 2019;8;1:60-64.
Faggioni M, Della Rocca DG, Mohanty S, et al. Cardiac Failure Review 2020;6:e04.
Andronache M, Drca N and Viola G. Arrhythmia & Electrophysiology Review 2019;8(2):111-5.
Garvanski I, Simova I, Angelkov L and Matveev M. European Cardiology Review 2019;14(3):165-8.
Aronis KN, Ali RL, Liang JA, et al. Arrhythmia & Electrophysiology Review 2019;8(3):210-9.
Johner N, Namdar M and Shah DC. Arrhythmia & Electrophysiology Review 2019;8(3):184-90.
- 1Hoffmann E, et al. EP Europace 2019, doi:10.1093/europace/euz155.;KuckKH, et al. EuropeanHeart Journal 2016, doi:10.1093/eurheartj/ehw285.
- 2KirchhofP, et al., ESC 2016 AF guidelines, EHJ 2016.;Calkins H, et al. HeartRhythm2017 May 12.
- 3Verma A, et al. N Engl J Med 2015;372:1812-1822.
- 4ProvidenciaR, et al. EP Europace 2017, doi:10.1093/europace/euw080.; MonnickendamG, et al. Operations Research for Health Care 2018, https://doi.org/10.1016/j.orhc.2017.12.001.; Velagi?V, et al. Journal of Cardiovascular Medicine 2017, doi:10.2459/JCM.0000000000000493.
- 5Kirchhof P, et al. ESC 2016 AF guidelines, EHJ 2016.; Calkins H, et al. Heart Rhythm2017 May 12.; Boveda S, et al. JACC Clin Electrophysiol2018, https://doi.org/10.1016/j.jacep.2018.07.007.; Su W, et al. Heart Rhythm 2020, https://doi.org/10.1016/j.hrthm.2020.06.020.
- 6Su W, et al. Heart Rhythm 2020, https://doi.org/10.1016/j.hrthm.2020.06.020
The content on this site is for information purposes only and is not a substitute for professional medical advice. The views and opinions expressed in the content on this site does not necessarily reflect or represent the views and opinions of Radcliffe Cardiology or Medtronic. See the device manual for information regarding the instructions for use, the implant procedure, indications, contraindications, warnings, precautions, and potential adverse events. For further information, contact your local Medtronic representative and/or consult the Medtronic website at medtronic.eu