Catheter ablation of peri-nodal and pulmonary veno-atrial substrates: should it be cool?

Catheter cryoablation (CRYO) is an alternative approach to radiofrequency (RF) ablation in the treatment of cardiac arrhythmias. The favourable lesion characteristics of CRYO and its unique properties of cryomapping and cryoadhesion make this newer approach especially suitable for the treatment of peri-nodal substrates, such as atrioventricular nodal re-entrant tachycardia and septal accessory pathway, and pulmonary veno-atrial substrate in atrial fibrillation. This review aims to present and discuss the data on the use of catheter CRYO for these substrates with special emphasis on its efficacy and safety compared with RF ablation.