Cryoballoon ablation beyond paroxysmal atrial fibrillation

PURPOSE OF REVIEW: Although radiofrequency-based pulmonary vein isolation (PVI) was considered the 'gold standard' for the treatment of atrial fibrillation for a long time, the cryoballoon has turned out to be a common alternative tool for atrial fibrillation ablation. Most of the data regarding cryoballoon-based ablation relate to patients with paroxysmal atrial fibrillation (PAF). In this review, we summarize recent knowledge on the usage of cryoballoon ablation for other conditions, especially persistent atrial fibrillation. RECENT FINDINGS: The cryoballoon is an effective ablation tool for PVI. As PVI is the first-line recommended procedural endpoint in atrial fibrillation ablation, it can be recommended not only for the treatment of PAF but also persistent atrial fibrillation and results in satisfying clinical outcomes. Recently, smaller studies and case reports were published reporting on cryoballoon ablation strategies beyond stand-alone PVI. These studies report a wide application spectrum of the cryoballoon and therefore potentially increase clinical success as well as the patient collective amenable to cryoballoon ablation. SUMMARY: Cryoballoon-based PVI can be recommended not only for patients with PAF but also for patients with persistent atrial fibrillation. Ablation strategies going beyond PVI need further evaluation, but might expand the use of the cryoballoon.