Abstract
Atrial fibrillation is the most common cardiac arrhythmia, significantly affecting quality of life and increasing risks of stroke and heart failure. Pulmonary vein isolation (PVI) is the cornerstone of catheter-based atrial fibrillation ablation. Beyond conventional radiofrequency (RF) energy, cryoballoon-based PVI has been developed to shorten procedure time and improve safety. This review discusses the mechanism of cryoenergy (Joule-Thomson expansion effect), the evolution through three cryoballoon generations (CB1, CB2, CB3), and key clinical evidence including the Cryo-FIRST trial and meta-analyses comparing cryoballoon with RF ablation. Results show cryoballoon ablation is associated with lower atrial fibrillation recurrence rates, shorter procedure times, and fewer serious cardiac complications (pericardial effusion, cardiac tamponade, vascular complications) compared to RF, though with a higher rate of phrenic nerve palsy. This method is now strongly recommended in ESC, AHA, and VNHA treatment guidelines.
