Intracardiac echocardiography. Non-fluoroscopy cryoballoon ablation of atrial fibrillation. Opinion on the issue

Cryoballoon ablation (CBA), along with radiofrequency ablation and pulsedfield ablation, has proven to be a safe and equally effective method with a short learning curve and minimal time investment. The CBA technique for atrial fibrillation (AF) involves cryoballoon pulmonary vein occlusion, which is confirmed by the absence of contrast leakage from the target vein on fluoroscopy, followed by cryotherapy. Numerous studies have demonstrated the negative impact of fluoroscopy on the human body. This is especially relevant in centers performing a high volume of surgical procedures. This paper presents the immediate and long-term results of non-fluoroscopy CBA of AF and describes the methodology. This technique involves intravascular ultrasound-guided (IVUS) manipulations, eliminating the need for contrast agent or ionizing radiation. It also simultaneously monitors the position of tools within the heart cavities and the echo-free space. The technique is described step by step and illustrated with IVUS screenshots and explanations. Over eight years of clinical experience using non-fluoroscopy CBA of AF has demonstrated that its effectiveness and safety are comparable to the classical technique using fluoroscopy and venography. It eliminates the negative effects of ionizing radiation and radiocontrast agents, maintains the "one shot" principle, does not increase surgical time, and is reproducible.