Persistent Atrial Fibrillation Using Arctic Front™ Cardiac Cryoablation System


Short Introduction to Persistent Atrial Fibrillation Section


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

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

  • 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,; 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,; Su W, et al. Heart Rhythm 2020,
  • 6Su W, et al. Heart Rhythm 2020,


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