Outcomes after cryoballoon ablation of paroxysmal atrial fibrillation with the PolarX or the Arctic Front Advance Pro: a prospective multicentre experience

BackgroundCryoballoon ablation for atrial fibrillation (AF) requires adequate contact between the pulmonary vein (PV) antrum and cryoballoon. The surge of intraballoon pressure during the initial phase of ablation may change the balloon's shape and compliance, resulting in balloon dislodgement and loss of PV occlusion. Without continuous monitoring, this phenomenon is often undetected but can be associated with incomplete PV isolation (PVI).MethodsPrimary cryoablation of AF was performed in 15 patients. PV occlusion status pre‐ and post‐freezing were analyzed with intracardiac echocardiography (ICE) and dielectric imaging‐based occlusion tool (DIOT) to calculate the incidence of expansion dislodgement of cryoballoon.ResultsA total of 105 cryoablation applications were performed on 57 veins, including three common ostiums of left pulmonary veins. In the evaluation of PV occlusion, both modalities reported consistent results in 86.7% of the assessments. Despite complete PV occlusion before ablation, peri‐balloon leak after initiation of freezing was detected by ICE in 5/22 (22.7%) applications and by DIOT in 8/25 (32%) applications.ConclusionIncidence of expansion dislodgement of the cryoballoon was detected in one‐fourth to one‐third of cryoablation applications depending on the imaging modality used, which was clinically frequent and significant.

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Incidence of cryoballoon expansion dislodgement during pulmonary vein isolation–An underappreciated frequent cause of incomplete isolation

Liao,

Tomaiko‐Clark,

Martinez

et al. 2023

“…Preliminary data 3–6 have shown that the acute safety and efficacy of POLARx are similar to those of the AFA‐Pro CB, although the nadir temperatures of POLARx are lower than those of AFA‐Pro. However, limited data on the medium‐term outcome of PV isolation by means of this new CB technology are currently available 7–9 . The aim of this study was to assess the medium‐term outcome of PV isolation by means of the POLARx CB in a large multicenter registry.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary vein isolation by means of a novel cryoballoon technology in paroxysmal atrial fibrillation patients: 1‐year outcome from a large Italian multicenter clinical registry

Bianchi,

De Simone,

Iacopino

et al. 2023

IntroductionRecently, a new cryoballoon (CB) technology (POLARx; Boston Scientific) has come onto the market. Preliminary data have shown that its acute safety and efficacy are similar to those of the first‐generation CB. The aim of this study was to assess the medium‐term outcome of pulmonary vein isolation (PVI) with the POLARxTM CB in a large multicenter registry.MethodsWe prospectively collected data on 125 consecutive patients with paroxysmal atrial fibrillation (AF) who underwent PVI by means of a novel CB system. Two cases of transient phrenic nerve palsy occurred, with full recovery in the 48h post procedure; no major procedure‐related adverse events were reported. During the 90‐day blanking period, 4 (3.2%) patients experienced an early recurrence. After the blanking period, over a mean follow‐up of 411 ± 62 days, 19 patients (15.2%) suffered an AF/atrial tachycardia (AT) recurrence. The 1‐year freedom from AF/AT recurrence was 86.4% (n = 17): 10 (8%) patients had an AF recurrence, 6 (4.8%) had an AT occurrence and 1 (0.8%) suffered both events. Patients with AF/AT recurrences had both a shorter deflation time and total deflation time. Moreover, CB ablations with measured TTI < 90 s and TTI < 60 s were more frequent in patients without AF/AT recurrence (88.5% and 77.4%, respectively) than in those who experienced at least one AF/AT recurrence (67.5% and 55.0%, p = .001 and p = .005, respectively).ConclusionThe novel POLARx cryo‐balloon system is safe and effective for PV isolation, displaying a 1‐year freedom from atrial arrhythmia recurrence of 86.4%, which is in line to that reported with AFA‐Pro CB or RF ablation.Clinical trial registrationCatheter Ablation of Arrhythmias with a High‐Density Mapping System in Real‐World Practice (CHARISMA). URL: http://clinicaltrials.gov/ Identifier: NCT03793998. Registration date: January 4, 2019.

“…The major drawback is a higher risk of nondurable, less transmural lesions, which may contribute to ineffective line of electrical block and longer procedure duration, with a higher risk of veins reconnection. 5 Recent technological advances have paved the way to novel ablation strategies [6][7][8] ; among these, high power (40-50 W) short duration (HPSD) has been proven to be a viable alternative in terms of efficacy and safety. 9 HPSD has been demonstrated to produce larger, more superficial lesions that should not increase complication rate.…”

Section: Introductionmentioning

confidence: 99%

High power short duration versus low power long duration ablation in patients with atrial fibrillation: A meta‐analysis of randomized trials

Parlavecchio,

Vetta,

Coluccia

et al. 2023

Self Cite

BackgroundHigh‐power‐short‐duration (HPSD) radiofrequency (RF) ablation is a viable alternative to low‐power‐long‐duration (LPLD) RF for pulmonary vein isolation (PVI). Nevertheless, trials showed conflicting results regarding atrial fibrillation (AF) recurrences and few data concerning complications. Therefore, we conducted a meta‐analysis of randomized trials comparing HPSD versus LPLD.MethodsWe systematically searched the electronic databases for studies published from inception to March 31, 2023 focusing on HPSD versus LPLD. The study endpoints were AF recurrence, procedural times and overall complications.ResultsFive studies enrolling 424 patients met the inclusion criteria (mean age 61.1 years; 54.3% paroxysmal AF; mean LVEF 58.2%). Compared to LPLD, HPSD showed a significantly lower AF recurrence rate [16.3% vs. 30,1%; RR: 0.54 (95% CI: 0.38–0.79); p = 0.001] at a mean 10.9 months follow‐up. Moreover, HPSD led to a significant reduction in total procedural time [MD: −26.25 min (95%CI: −42.89 to −9.61); p = 0.002], PVI time [MD: −26.44 min (95%CI: −38.32 to −14.55); p < 0.0001], RF application time [MD: −8.69 min (95%CI: −11.37 to −6.01); p < 0.00001] and RF lesion number [MD: −7.60 (95%CI: −10.15 to −5.05); p < 0.00001]. No difference was found in either right [80.4% vs. 78.2%; RR: 1.04 (95% CI: 0.81–1.32); p = 0.77] or left [92.3% vs. 90.2%; RR: 1.02 (95% CI: 0.94–1.11); p = 0.58] first‐pass isolation and overall complications [6% vs. 3.7%; RR: 1.45 (95%CI: 0.53–3.99); p = 0.47] between groups.ConclusionIn our metanalysis of randomized trials, HPSD ablation appeared to be associated to a significantly improved freedom from AF and shorter procedures, without increasing the risk of complications.