Devices and methods for creating radial-linear lesions in pulmonary vein antral tissue are disclosed. In an embodiment, a device includes an elongate shaft structure with a distal tip ablation region including a spline and an ablation element slidably coupled to the spline. The ablation element includes at least one of an ultrasound emitter, a high frequency ultrasound emitter, a laser, a radiofrequency electrode, a virtual radiofrequency electrode, or a cryogenic source. A backing balloon may be configured to push or pull the spline and the ablation element toward or against the pulmonary vein antral tissue. In an embodiment, the distal tip ablation region includes a splineless cryoballoon with at least one thermally conductive region.
