Comparison of procedural efficacy, balloon nadir temperature, and incidence of phrenic nerve palsy between two cryoballoon technologies for pulmonary vein isolation: A systematic review and meta‐analysis

Abstract Introduction In May 2020, a novel cryoballoon system (POLARx; Boston Scientific) became available for catheter ablation of atrial fibrillation (AF). The design of the cryoballoon is comparable to the Arctic Front Advance Pro (AFA‐Pro; Medtronic), but it is more compliant during freezing. We...

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Bibliographic Details
Published in:Journal of Cardiovascular Electrophysiology
Main Authors: Assaf, Amira, Bhagwandien, Rohit, Szili‐Torok, Tamas, Yap, Sing‐Chien
Format: Article in Journal/Newspaper
Language:English
Published: Wiley 2021
Subjects:
Arctic
Online Access:http://dx.doi.org/10.1111/jce.15182
https://onlinelibrary.wiley.com/doi/pdf/10.1111/jce.15182
https://onlinelibrary.wiley.com/doi/full-xml/10.1111/jce.15182
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Summary:Abstract Introduction In May 2020, a novel cryoballoon system (POLARx; Boston Scientific) became available for catheter ablation of atrial fibrillation (AF). The design of the cryoballoon is comparable to the Arctic Front Advance Pro (AFA‐Pro; Medtronic), but it is more compliant during freezing. We compared the procedural efficacy, biophysical parameters, and risk of phrenic nerve palsy (PNP) between the two cryoballoons. Methods Embase, MEDLINE, Web of Science, Cochrane, and Google Scholar databases were searched until June 1, 2021 for relevant studies comparing POLARx versus AFA‐Pro in patients undergoing pulmonary vein isolation (PVI) for AF. Results A total of four studies, involving 310 patients were included. There was no difference between the two groups for outcomes regarding procedural efficacy: acute PVI (odds ratio [OR]: 0.43; 95% confidence interval [CI]: 0.06 to 3.03; p = .40), procedure time (mean difference [MD]: 8.15 min; 95% CI: −8.09 to 24.39; p = .33), fluoroscopy time (MD: 1.32 min; 95% CI: −1.61 to 4.25; p = .38) and ablation time (MD: 1.00 min; 95% CI: −0.20 to 2.20; p = .10). The balloon nadir temperature was lower for all individual pulmonary veins (PV) in POLARx compared with AFA‐Pro (MD: −9.74°C, −9.98°C, −6.72°C, −7.76°C, for left superior PV, left inferior PV, right superior PV, and right inferior PV, respectively; all p < .001). The incidence of PNP was similar between groups (OR: 0.79; 95% CI: 0.22 to 2.85; p = .72). Conclusion In AF patients undergoing PVI, POLARx and AFA‐Pro had a similar procedural efficacy. Balloon nadir temperatures were lower with POLARx, however, the incidence of PNP was similar.

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