<International Circulation>:What’s your opinion on the cryoballoon ablation procedure in atrial fibrillation?

   《国际循环》：您对球囊冷冻消融技术有何看法?
    Dr Day: The cryoballoon is certainly an excellent option perhaps for the center that is just beginning an atrial fibrillation program. The cryoballoon learning curve may be a bit easier than what we have been doing over the past decade with the point-by-point radiofrequency ablation approach. However， with the cryoballoon approach， probably one of the most significant limitations， in my mind at least and the reason why we haven’t adopted it so readily， is the issue of phrenic nerve injury. The phrenic nerve continues to be a problem particularly when using the cryoballoon in the right upper pulmonary vein. There are techniques that have been advocated whereby you can have real-time monitoring of the phrenic nerve but in my mind， whether it is a temporary phrenic nerve paralysis or permanent， any phrenic nerve paralysis is too much for me. Having done several thousand radiofrequency catheter ablation procedures for atrial fibrillation， I have never encountered a phrenic nerve injury. So， for me， even one phrenic nerve injury is too much. The other issue with the cryoballoon is that it is probably a procedure better suited to the patient with paroxysmal AF. For the patient with more persistent forms of atrial fibrillation， you are probably going to have to perform adjunctive ablation. In that case， the cost of a cryoballoon and then the cost of a radiofrequency irrigated-tip catheter ablation may be prohibitive in that setting.

    Dr Day: 房颤射频手术最初阶段使用球囊冷冻技术是一种很好的选择。该技术曲线相比于在我们过去20年中传统的点对点射频技术可以说更简单。*但它有一个关键的局限性，这也是我们不能完全接受它的原因，即膈神经损伤，当使用球囊导管在右上肺静脉消融时膈神经损伤较为常见。即便现在有实时监测膈损伤的技术，但我还是认为无