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

• 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: 2021
• Subjects: Arctic
• Online Access: https://pure.eur.nl/en/publications/30f06dbb-856b-4502-bf11-4a40d9b06de0; https://doi.org/10.1111/jce.15182; https://pure.eur.nl/ws/files/42371305/jce.15182.pdf; http://www.scopus.com/inward/record.url?scp=85111349749&partnerID=8YFLogxK

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.