Contours of perfection: Evolution of techniques and outcomes of pulmonary vein isolation with a new cryoballoon

Atrial fibrillation (AF) is one of the most prevalent forms of arrhythmia, affecting approximately 1-2% of the population. Its prevalence is expected to notably increase in the coming decades due to an aging population. AF negatively impacts quality of life and cardiac function, increasing mortality risk. Catheter ablation has become a key method for treating AF, particularly for achieving pulmonary vein isolation (PVI). While traditional radiofrequency ablation remains widespread, recent years have seen increasing attention towards the single-shot cryoballoon ablation technique.This article provides an analysis of contemporary approaches to the diagnosis and cryoballoon ablation of AF, examining data on the application of new cryoballoon systems. Emphasis is placed on comparing Arctic Front and PolarX technologies, including differences in components and application methods. Various ablation approaches are described, including the direct approach, «hockey stick» method, pull-down, and pull-away techniques, focusing on their clinical efficacy and risk reduction of phrenic nerve injury.Key differences between cryoablation systems that influence clinical outcomes are investigated. The article concludes on the importance of re-evaluating skills and practices when introducing new technologies, to achieve the highest efficiency and safety in treating AF patients. Further research and continuous professional development are deemed essential for improving treatment outcomes and understanding new catheter ablation technologies.