Segmental Non-Occlusive Cryoballoon Ablation of Pulmonary Veins and Extra-Pulmonary Vein Structures: Best Practices III.

Abstract

Although cryoballoon ablation of atrial fibrillation (AF) has been traditionally guided by pulmonary vein (PV) occlusion, there is evidence and growing interest in performing segmental, non-occlusive cryoballoon ablation to target not only large/common PVs, but extra-PV structures such as the left atrial (LA) roof and posterior wall in conjunction with PV isolation. To date, a number of studies have demonstrated improved clinical efficacy associated with non-occlusive cryoballoon ablation of the LA roof and posterior wall in addition to PV isolation, particularly in patients with persistent AF. Not only the cryoballoon can be utilized for targeting extra-PV structures through segmental, non-occlusive ablation, but the large size and durability of cryolesions coupled with the enhanced stability afforded through cryoadhesion render the cryoballoon an effective tool for such an approach. This manuscript reviews the rationale and the practical approach to segmental, non-occlusive cryoballoon ablation of large/common PV antra and the LA roof and posterior wall.