Heart rhythm O2 · 2025
Differences between 2 cryoballoon systems in achieving successful pulmonary vein isolation in patients with challenging anatomies.
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Yamashita Shuhei, Takatsuki Seiji, Yano Shuhei, Himeno Yukihiro, Yamaoka Koki, Ibe Susumu, Katsumata Yoshinori, Nishiyama Takahiko, Kimura Takehiro, Ieda Masaki
Аннотация
BACKGROUND: A new technology, the POLAR cryoballoon system, was designed to enhance maneuvering and stabilizing catheter positions with a softer balloon and more deflectable sheath. These novel characteristics may help achieve successful pulmonary vein (PV) isolation in difficult cases when conventional balloons were used.
OBJECTIVE: This study aimed to investigate the differences in the lesion profiles, touch-up radiofrequency ablation (RFA) rate, and anatomical predictors of acute PV isolation between the POLAR and Arctic Front Advance Pro (AFA-Pro).
METHODS: This retrospective study included 338 consecutive patients who underwent a first cryoballoon ablation for paroxysmal atrial fibrillation at Keio University Hospital from April 2019 to September 2023. Using propensity score matching, we extracted 135 pairs treated with a POLAR or AFA-Pro, compared the procedural outcomes, and explored the anatomical predictors related to successful PV isolations.
RESULTS: In the matched cohort of 270 patients (median age 67 years [59-73], 77% male), 1535 cryoballoon applications were delivered for 1063 PVs, and touch-up RFA was performed for 84 PVs in 67 patients. The rate of touch-up RFA was significantly lower for the right inferior PV (RIPV) in the POLAR group (9.8% vs 21.6% P = .013), whereas there was no significant difference for the other PVs. A lower RIPV frontal angle was linearly associated with a more favorable outcome for the POLAR group than for the AFA-Pro group (interaction P = .0385).
CONCLUSION: The touch-up RFA rate for the RIPV was significantly lower in the POLAR group than in the AFA-Pro group, with a particularly pronounced difference for inferiorly oriented RIPVs.
OBJECTIVE: This study aimed to investigate the differences in the lesion profiles, touch-up radiofrequency ablation (RFA) rate, and anatomical predictors of acute PV isolation between the POLAR and Arctic Front Advance Pro (AFA-Pro).
METHODS: This retrospective study included 338 consecutive patients who underwent a first cryoballoon ablation for paroxysmal atrial fibrillation at Keio University Hospital from April 2019 to September 2023. Using propensity score matching, we extracted 135 pairs treated with a POLAR or AFA-Pro, compared the procedural outcomes, and explored the anatomical predictors related to successful PV isolations.
RESULTS: In the matched cohort of 270 patients (median age 67 years [59-73], 77% male), 1535 cryoballoon applications were delivered for 1063 PVs, and touch-up RFA was performed for 84 PVs in 67 patients. The rate of touch-up RFA was significantly lower for the right inferior PV (RIPV) in the POLAR group (9.8% vs 21.6% P = .013), whereas there was no significant difference for the other PVs. A lower RIPV frontal angle was linearly associated with a more favorable outcome for the POLAR group than for the AFA-Pro group (interaction P = .0385).
CONCLUSION: The touch-up RFA rate for the RIPV was significantly lower in the POLAR group than in the AFA-Pro group, with a particularly pronounced difference for inferiorly oriented RIPVs.