Cryoballoon ablation as first-line therapy of paroxysmal atrial fibrillation: dusk of global warming and the dawn of a new ice age era?

Abstract

This editorial refers to ‘Isolating the pulmonary veins as first-line therapy in patients with lone paroxysmal atrial fibrillation using the Cryoballoon’ by M. Namdar et al. , on page 197 The introduction of catheter ablation for the treatment of supraventricular arrhythmias in the early 1980s initially with the delivery of intra-cardiac DC shocks and finally in 1987 with the introduction of radiofrequency energy changed forever the management of supraventricular tachycardias.1–3 Despite the safety, reproducibility, and high efficacy rates, catheter ablation of supraventricular tachycardias is still not considered first-line therapy. Similarly, despite many attempts with different energy sources radiofrequency ablation remains the gold standard. The proposal for a catheter-based approach in the mid 1990s for the treatment of atrial fibrillation was met with significant scepticism. Initial attempts using extensive lines trying to reproduce the Cox-Maze approach were associated with mediocre results and untenable procedure and fluoroscopic times.4,5 Nonetheless perseverance and a better understanding of the mechanisms of atrial fibrillation as …