Korean Circ J.  2019 Nov;49(11):991-1001. 10.4070/kcj.2019.0226.

Current Status of Atrial Fibrillation Ablation with Balloon Strategy

• Chun JK
• Bordignon
• Chen S
• Tohoku S
• Bologna F
• Urbanek L
• Schmidt BH

• KMID: 2460523
• DOI: http://doi.org/10.4070/kcj.2019.0226

Abstract

Catheter ablation of atrial fibrillation (AF) has been established worldwide and is recommended for symptomatic paroxysmal AF patients according to international guidelines. Importantly, the cornerstone of any AF ablation represents pulmonary vein isolation (PVI). Traditional radiofrequency (RF) point by point ablation within a 3D electroanatomic left atrial (LA) map requires profound understanding of LA anatomy and electrophysiology. This ablation strategy can be highly efficient and safe if performed in experienced hands and centers. However, procedural complexity causes a long learning curve and has limited its wide spread utilization. In contrast, balloon based PVI ablation strategies are based on an anatomic principle. Currently, two balloon types (cryoballoon and laserballoon) have been adopted to clinical routine. Both balloons are positioned at the target PV and circumferential energy ablation is enabled. This simplified anatomic approach facilitates reaching the procedural endpoint of PVI and demonstrated less operator dependency. Therefore, balloon PVI appears to be associated with improved procedural reproducibility and safety. Importantly, large scale randomized trials proved non-inferiority of balloon guided AF ablation (cryothermal and laser energy) vs. experienced operators using traditional "gold standard" RF ablation in paroxysmal and persistent AF. Ongoing technological refinements of both balloons as well as the introduction of novel energy dosing strategies and ablation targets may potentially impact the current way of ablating AF in future. This review will summarize current clinical experience of contemporary balloon devices and will look into future developments.

Keyword

Atrial fibrillation; Ablation balloon technology

MeSH Terms

Atrial Fibrillation*
Catheter Ablation
Electrophysiology
Hand
Humans
Learning Curve
Pulmonary Veins

Figure

• 

  Figure 1 Summary of technological specifics of contemporary balloon devices and RF ablation. RF = radiofrequency; PVI = pulmonary vein isolation; RFC = radiofrequency current; 3D = three-dimensional.

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  Figure 2 LSPV occlusion with 28 mm cryoballoon and real time visualization of electrical PV isolation. CS = coronary sinus; Eso = esophagus; LSPV = left superior pulmonary vein; PV = pulmonary vein; RAO = right anterior oblique; SC = spiral catheter.

• 

  Figure 3 (A) Baseline PV angiogram of RSPV before laser PVI showing 2 RSPV branches and catheter settings. (B) LB occlusion of RSPV avoiding a distal position. (C) Endoscopic view of boith RSPV branches. CS = coronary sinus; Eso = esophagus; LB = laserballoon; RAO = right anterior oblique; PV = pulmonary vein; PIV = pulmonary vein isolation; RSPV = right superior pulmonary vein; SVC = superior caval vein.

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